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User`s Manual - Frank`s Hospital Workshop

1. Edit Baro Press RESP RATE EDITOR ON OFF i SELECT ET CO2 UNITS mmHg KPa K Select Unit UNIT CHANGE ERASES TREND CONT CANCEL TRENDS ERASED M TRENDS RETAINED A A y y y SpO2 SETUP OPTIONS SpO2 TIMERS l MONITOR OPTIONS 1 MONITOR OPTIONS 2 RUN IABP SIZE NEXT P RUN HELD SPEC BAD NEXT RUN DISP KCLK VER NEXT RUN SER CLOCK REC NEXT MAIN L MAIN KH MAIN MAIN Invert CCD IABP MODE AVAILABLE DISPLAY HELD TIMER Yy VES NO ON OFF KEYCLICK VOLUME NOVACOM INTERFACE ps RUN SET PREV NEXT A On Off On Off MAIN i i Up Down ANALOG MODULE INTERFACE 4 4 4 SET PREV NEXT PLETH AUTOSIZE SPECIAL ALERT DELAY VER ENG XXXX XX Y ON OFF SE E e NEXT NOVACARD INTERFACE i i SET PREV NEXT On Off C Select desired delay time p t DD MMM YYY XX XX XX e NEXT TELECAP INTERFACE ALER
2. M 59 Auto Alert Limits uie e gne ebd e mds 60 ETCO2 Auto Alert Limits eit ee RIO eO eet een 61 Respiratory Rate Auto Alert Limits nennen nennen nennen 61 SpO2 Auto Alert Ermits aee eee er e i re He eee decns 61 Pulse Rate Auto Alert Limits esses nennen rennen 62 Setting Alert Limits Manually sessi eee en entren en nennen 62 Alert Vol me o shi bem peteret DR D GIRO eiae 63 Audio MMe M ES 63 Limit Alerts Latched Unlatched AAA 64 Alert Limit Settings Retained Defaults A 64 Limit Alerts Delayed Instant AAA 65 Alert Bar Latched Unlatched Off AAA 66 Trend Memory Display eeeeeeeee essen neee nenne nennen nnns nn nnmnnn nnmnnn nnmnnn nenna innen 67 OVetVIeW Jane vospeoieap EES IRR DRTPURUIHE ERR 67 Graphical Trend Display 2 te E EI Ee erae eee Eeer 67 Dual Trend Displays rt Rer eR GR RR P ERR ee 68 ETCO and Respiratory Rate Trend Display Scales sss 69 Dual SpO and Pulse Rate Trend Display Scales A 69 Histogram Trend Display esee iet reprehe etie ie dee ip EEE 70 Trend Data Compression indere tetendit ope I ERE p ree E eri SER TES 70 Erase bI Nu M 71 Trend Print eegend este e a a E ET e deiecit por erred 71 Trend and NOVACARD Memory Module esee nennen 71 Miscellaneous Features seesseeeses
3. Channel Parameter Pin No Wire Pair Specifications 0 End Tidal Value 1 Black White 10 mv21 Torr 1 Resp Rate 3 Brown White 7mv 1 breath min 2 Capnogram 5 Red White 10mv Torr 3 Saturation Value 7 Orange White 10mv 1 4 Heart Rate 9 Yellow White 4mv beat min 5 Plethysmogram 11 Green White not scaled 1v max Alert Output 15 active low The White wire on all twisted pairs is the reference ground Calibrating External Recorder To set up external devices such as strip chart recorders by outputting zero mid and full scale reference voltages for each parameter The Analog Module Interface must be programmed in order to proceed See Selecting Analog Module Interface on page 105 and Connecting the Analog Module on page 106 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTIONS 2 appears 3 Press the REC key CALIBRATE RECORDER appears If the Analog Module has not been programmed as a serial interface the REC will not appear See Selecting Analog Module Interface on page 105 4 Press ZERO HALF or FULL as desired Press ZERO for zeroing all channels this will program zero volts on all parameter channels Press HALF for half scale each parameter will be set to 0 5 volts Press FULL for full scale each parameter will be set to 1 0 volts 5 Press RUN or PREV as desired Press RUN to return to the Main
4. H G Bn ALET TRHD SCALE CAL MEHU CO Display Units COSMO can display CO values in any of three units of measure millimeters of Mercury mmHg kilo Pascals kPa or percent To change the CO display unit of measure 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Press the UNITS key SELECT CO2 UNITS appears The current CO display unit of measure flashes 3 Press mmHg kPa or as desired mmHg Display CO in millimeters of Mercury kPa Display CO in kilo Pascals Display CO in percent 4 If the units are changed UNIT CHANGE ERASES TREND appears Press CONT continue or CANCEL as desired CONT Change the units display and erase all stored trend data CANCEL Do not change the display units Leave stored trend data intact If no key is pressed the menu times out and CANCEL is selected automatically 5 Press RUN to return to the Main Menu 32 CO 5MO User s Manual Rev 04 Respiratory Rate Monitoring CO and Respiratory Rate Respiratory Rate CO SMO s Respiratory Rate display is the result of averaging the inverse of the eight most recently detected time intervals between CO waveforms COSMO measures Respiratory Rate in the range of 0 150 br min The display is accurate to 1 br min The monitor provides audible and visible high and low limit alerts for Respiratory Rate See Alerts on page 59 With each breath an icon of a pair of lungs flashe
5. Pulse Rate Display Averaging Pulse Rate is determined by a fixed eight second averaging period Rev 04 CO SMO User s Manual 51 Section 7 52 MES Sr ae Pulse Beep Volume Pulse Beep Volume COSMO is equipped with an audible pulse beep feature that allows the user to hear changes in the patient s SpO and pulse rate An audible beep occurs with each detected pulse beat The time between beeps indicates the pulse rate The pitch of the beep varies with the SpO value The highest pitched tone sounds while the SpO value is greater or equal to the SpO High Alert limit setting minus 3 percent The beep s pitch decreases with each one digit drop in SpO below that level There are thirty two different tones If the SpO value drops more than 32 percent below the SpO high alert limit setting the beep remains at the lowest pitched level To vary the pulse beep volume Press the MENU key CO2 OPTIONS appears Press the NEXT key SYSTEM OPTIONS appears Press the AUDIO softkey SET AUDIO FEATURES appears Press the PULSE key SET PULSE VOLUME appears The current pulse volume setting 0 7 is displayed between the up and down arrows A setting of 0 turns off the pulse beep feature Press T or J to increase or decrease the pulse volume setting Press RUN to return to the Main Menu Signal Bar The SIGNAL bar reflects the pulsatile signal strength detected by the SpO sensor Strong pulsatile signa
6. 1 5 x 5 inch 3 08 x 12 7 cm Cold Cathode Display CCD Additional Features e Audible SpO Trend Feature Pitch of Pulse Rate beep tracks the SpO value user selectable e Alert Limits Operator selectable automatic or menu selected High and Low limits for ETCO gt Respiratory Rate SpO and Pulse Rate Visible alert is immediate audible alert occurs 10 seconds after violation of set limit e 2 Minute Silence When AUDIO key is pressed deactivates audible alerts for two minutes Indicated by illuminated 2 minute LED e Audio Off Press and hold AUDIO key for 3 seconds to deactivate audible alerts Indicated by flashing ON Audio Off LED e Trend Memory 24 hour trend memory capacity Battery backed On screen 12 hr 8 hr 2 hr or 30 minute graphical and histogram displays User defined Events are stored in memory Trend and Histogram information can be printed e Digital Data Output Serial RS232 data output compatible with Hewlett Packard ThinkJet Printer Seiko DPU 411 Thermal Printer Computer Interface Analog Output Module Optional Provides outputs for strip chart recorder applications CO 10 mV Torr Respiratory Rate 7 mV br min Capnogram 0 1 0 V max SpO 10 mv Pulse Rate 4 mV bpm Plethysmogram 0 1 V max e Sampling System Standard Allows gas sampling of non intubated patients e Neonatal Airway Adapter Less than 0 5 cc deadspace e Internal Real Time Clock e Alert Bar e NOVACARD Interfac
7. Status Messages Message Displayed Possible Explanation NO SPO2 UPDATE Insufficient light where is time in seconds after 99 seconds display shows Possibly caused by motion or poor sensor placement resulting in poor signal INCOMP SPO2 PROBE A non SuperBright sensor is connected Sensor is faulty Remove sensor from use and contact qualified service personnel SpO2 INSUF LIGHT Sensor placed on a site too thick or opaque for adequate light transmission Reposition the sensor A non SuperBright M sensor is connected SpO2 LIGHT INTERF Light Interference ambient light sources sunlight warming lights etc are interfering with sensor light sources Shield the sensor from ambient light sources SpO2 LOW SIGNAL Low Signal Strength the pulse strength detected by the sensor is too weak for proper monitor operation Reposition sensor SpO2 FAULTY PROBE RD Sensor faulty Remove sensor from use and contact qualified service personnel Sensor Red LED has failed or the cable connections are open or shorted SpO2 FAULTY PROBE IR Sensor faulty Remove sensor from use and contact qualified service personnel Sensor Red IR has failed or the cable connections are open or shorted PULSE OUT OF RANGE Pulse rate is less than 30 bpm or is greater than 250 bpm MONITOR AUDIO OFF DISABLED Displayed if user tries to enable Audio Off mode by pressing and holding
8. hh a 2 digit hour based on a 24 hour clock 00 23 mm a 2 digit minute ss a 2 digit second lt cr gt lt 1f gt is a carriage return line feed sequence COSMO User s Manual Rev 04 Selecting NOVACOM1 Interface External Devices Mode c Clear Trends Clear Trends mode allows the user to remotely clear the CO SMO trend memory This action has the same result as the monitor s Clear Trend function in that trend memory and the Trend Page displays are cleared Note Use this remote Clear Trends function with care as there is no way to undo the clear command once issued To clear the COSMO trend memory the computer must send an ASCII c character The CO SMO will echo the c followed by a lt cr gt lt 1f gt and then the trend memory will be cleared Selecting NOVACOM1 Interface To configure the COSMO to work with the NOVACOMI I computer Interface 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTIONS 2 appears 3 Press the SER serial interface key and the currently selected interface appears Available interfaces include INTERFACE UNUSED PRINTER INTERFACE NOVACOMI INTERFACE ANALOG MODULE INTERFACE MEMORY CARD INTERFACE TELECAP INTERFACE and TELESAT INTERFACE 4 Press PREV previous or NEXT to select NOVACOM1 INTERFACE 5 Press the SET key The NOVACOM I Interface is selected 6 Press RUN to return to the Main Menu
9. is set by pushing the ON LINE button once OFF is set by pushing the FEED button once The printer will confirm each selection Repeat for DIP SW 2 and 3 86 co sMO User s Manual Rev 04 Selecting a Specific Printer Using a Printer The DIP switch settings for the Model 7100 are as follows DIP SW settings mode Dip SW 1 1 OFF Input Serial 2 ON Printing Speed High 3 ON Auto Loading ON 4 OFF Auto LF OFF 5 ON Setting Command Enable 6 OFF Printing T LN 3 Density 8 ON 100 Dip SW 2 1 ON Printing Columns 40 2 ON User Font Back up ON 3 ON Character Select Normal 4 OFF Zero Normal 5 ON International 6 OFF Character 7 ON Set 8 OFF U S A Dip SW 3 1 ON Data Length 8 bits 2 ON Data Parity No 3 ON Parity Condition Odd 4 OFF Busy Control H W Busy 5 ON Baud 6 OFF Rate 7 ON Select 8 OFF 9600 bps Continue Push On line SW Write Push Paper feed SW DIP SW Set Mode cannot be cancelled once it is initiated Answer ON or OFF for every setting Note More information about DIP switch settings can be found in the Seiko DPU 414 Thermal Printer Operation Manual 5 When the printer finishes writing the new settings to memory DIP SW setting completed is printed out and the printer returns to ON LINE mode Never turn the printer of
10. 120 bpm IABP ratio 1 3 then displayed Pulse Rate should be 120 120 3 160 beats min Since while in IABP Mode the pulse rate display will be affected by motion or other artifact the accuracy of the Pulse Rate display can usually be used as an indicator of the quality of the SpO display Making IABP Mode Available Before the clinician can use IABP Mode the mode must be made available to the Main Menu The monitor s factory default settings do not allow use of IABP Mode Once IABP Mode is available to the Main Menu a softkey labelled IABP appears in the AVERAGING SELECTIONS menu To allow IABP Mode to be selected from the Main Menu system 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Press the NEXT key SPO2 SETUP OPTIONS appears 3 Press the IABP key IABP MODE AVAILABLE appears The current setting flashes 4 Press YES or NO as desired YES An IABP softkey appears in the AVERAGING SELECTIONS menu NO IABP Mode cannot be activated from the Main Menu NOTE Once the decision on IABP Mode Main Menu availability is made that choice will remain in effect even if the monitor is turned off and on until changed by the user 5 SPO2 SETUP OPTIONS reappears Press RUN to return to the Main Menu 56 co sMO User s Manual Rev 04 IABP Mode eS Rev 04 Monitoring SpO and Pulse Rate Turning IABP Mode On Off Once IABP Mode is made available to the Main Me
11. 70 co sMO User s Manual Rev 04 Erase Trend Memory Trend Memory Display Rev 04 For Respiratory Rate SpO and Pulse Rate the upper extent of the bar represents the maximum value and the bottom of the bar the minimum value stored during that particular compression period The value displayed above the graph represents the minimum value stored over the compression period Erase Trend Memory a Za Trend information is retained in memory even if COSMO is turned off Each time the monitor is turned on the message ERASE STORED TREND is displayed The user can select YES to erase the contents of trend memory or press NO to keep the previously stored trend data intact If trend information is not erased at power up new data will be appended to the old data already in memory Additionally the user can at any time enter the trend menu and erase stored trend information To erase stored trend information from within the trend menus Press the TRND key Wait for the trend to be displayed Press the NEXT key TREND OPTIONS appears Press the ERASE key ERASE STORED TRENDS appears Press YES or NO as desired YES Erase stored trend memory data TRENDS ERASED is briefly displayed NO Keep stored trend memory data intact TRENDS RETAINED is briefly displayed Trend Print If PRINTER INTERFACE is selected in the MONITOR OPTIONS 2 portion of the menu system a PRNT key is displayed in the TREND OPTIONS menu Press the PRNT key
12. IS AUDIO OFF Information COL B EVENT MARK WW Data Scales T DE e g ET BE Kai TRENDING STARTS ON BARBIE o Aei settings New Alert O HL L LOW t r RR HIGH 35 imit setings E Er A Hr Cen He Re B pM RR HIGH 33 cares HISTOGRAM Beginning of Histogram Total Elapsed Time 88 19 12 Non monitoring Time 08 02 88 92 co sMO User s Manual Rev 04 Interpreting Printer Output Using a Printer TE HISTOGRAM E of Total Elapsed Time 00 19 12 Non monitorins Time 08 82 88 ETCO2 mmHg Limit Alert Below lims Status Within Ims Above lims gt 7i 64 71 56 63 48 55 44 47 32 39 24 3l 16 23 8 15 i 7 Average 50 Min 48 Max 86 Histogram Data RESP RATE br 7min Below 1 ims ax Within lms 160 Se Above lims KE gt 99 9 98 99 B 80 89 a 70 79 g DR 69 ax 58 59 a 4B 49 EK 38 39 Hi 20 29 160 18 18 0 Jr 8 a be 8 Average Average 23 Min 23 Max 23 Y Min amp Max END OF TREND PRINTOUT Rev 04 CO SMO User s Manual 93 Section 13 Interpreting Printer Output Graphical Data A graphical depiction of trend memory is printed after the header for all printouts except the tabular and waveform modes Column A and B Information The next two lines refer to Columns A and B in the printout Column A represents the monitor s audible alarm status A mark black bar in
13. or X character The CO SMO will echo x and stop communication Mode 4 SpO Waveform In SpO Waveform mode the saturation pulse rate and SpO display messages are continually transmitted at one second intervals Plethysmogram waveform data is also continually transmitted 48 times a second To enter SpO Waveform mode the computer must send an ASCII 4 character The CO2SMO will echo the 4 followed by a cr 1f and then enable communication The data format is MS px Z cor lf sent once a second ptt lt cr gt lt 1lf gt sent 48 times a second where M Event Marker identifier M event marked no event S an identifier for a 3 digit ASCII SpO value to follow P an identifier for a 3 digit ASCII Pulse rate value to follow Z an identifier for a 2 digit ASCII SpO status value a 3 digit ASCII value a 2 digit ASCII value p an identifier for a 2 digit waveform data point to follow a 2 digit ASCII value in the range 0 99 lt cr gt lt 1f gt is a carriage return line feed sequence The Z SpO message value represents the current status of the parameter A value of 00 is returned if no error is active Refer to Mode 1 Real Time on page 99 for a complete list of error messages To exit SpO Waveform mode the computer must send an ASCII x or X character The CO SMO will echo x and stop communication
14. Once an SpO sensor is connected to the monitor and properly applied to the patient COSMO displays Sp Pulse Rate a plethysmographic waveform and a SIGNAL bar that gives a qualitative indication of the strength of the pulsatile signal the monitor is receiving If necessary press to display the plethysmogram and signal bar SpO Display Averaging The Oxygen Saturation value is determined in part by the user selected SpO display averaging Averaging affects only the numerical display and not the plethysmogram A short averaging time provides faster response to changing patient conditions while a longer averaging time helps eliminate the interference from motion or other artifact With two second 2s averaging displayed SpO is based on the two most recent seconds of collected saturation data With eight second 8s averaging displayed SpO is based on the eight most recent seconds of saturation data All data collected within the sliding 2 or 8 second time period is averaged the result is displayed as SpOp To change the SpO display averaging 1 Press the MENU Key CO2 OPTIONS appears Press the NEXT key SYSTEM MENU OPTIONS appears Press the AVG averaging key AVERAGING SELECTIONS appears Press the SpO2 key SELECT SpO2 AVERAGING appears The currently selected averaging time flashes X op Mo 5 Press 2s two second or 8s eight second averaging AVERAGING SELECTIONS reappears 6 Press RUN to return to the Main Menu
15. Selecting Analog Module Interface To configure the COSMO to work with the Analog Module 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTIONS 2 appears 3 Press the SER serial interface key and the currently selected interface appears Available interfaces include INTERFACE UNUSED PRINTER INTERFACE NOVACOMI INTERFACE ANALOG MODULE INTERFACE MEMORY CARD INTERFACE TELECAP INTERFACE and TELESAT INTERFACE 4 Press PREV previous or NEXT to select ANALOG MODULE INTERFACE 5 Press the SET key The Analog Module interface is selected 6 Press RUN to return to the Main Menu Rev 04 CO SMO User s Manual 105 Section 14 Selecting Analog Module Interface Connecting the Analog Module The CO SMO must be configured for Analog Module Interface to operate with the Analog Output Module See Selecting Analog Module Interface on page 105 1 Connect the Analog Output Module to the monitor s rear panel RS232 connector 2 Tighten the two spring loaded screws that secure the Analog Module to the rear panel 3 Connect the interface cable to the Analog Module s 15 pin connector The Interface Cable PN 6045 00 connects to the 15 pin D connector on the Analog Module then terminates to six twisted pair wires The six twisted pair wires on the open end of the interface cable correspond to channels 0 5 as listed below Connect these wires to the analog recorder
16. The COSMO Service Manual Catalog No 5758 90 contains procedures and safety test instructions component parts lists circuit diagrams theory of operation and other information to assist qualified service personnel in servicing the monitor Battery Maintenance If the monitor has not been used or powered by AC mains for an extended time 3 months or more allow the battery to charge for 12 hours before use The monitor may not power up on battery power if the battery is not sufficiently charged Allow the battery to charge for 12 hours before initial use refer to the following diagram for charging instructions To charge the battery connect the line cord to an AC source and set the rear panel power switch ON 1 Check that the front panel icon is green Charge the battery for 12 hours NOVAMETRIX DICAL SYSTEMS ING E USA RS232C NOVAMETRIX ACCESSORIES CAUTION FEDERAL U S A LAW RESTRICTS THIS DEVICE TO SALE DISTRIBUTION OR USE BY OR ON THE ORDER OF ALICENSED MEDIC ABR AGTITIONER 2 The internal battery may slowly discharge over long periods of non use COSMO User s Manual Rev 04 Mains Voltage Configuration Maintenance If the battery requires replacement refer to the COSMO Service Manual Catalog No 5758 90 for instructions Have this procedure performed by qualified service personnel only there are no user serviceable parts inside the monitor Mains Voltage Configuration The rear panel power
17. 23 BRM INSP 5 mmHg 15 29 98 SP02 98 PULSE 18B bpm a ETCO2 40 mmHo RR 23 BRM INSP amp mmHs Capnogram or Plethysmogram Waveform Format If the capnogram or dual waveform display is selected a capnogram waveform is printed if the plethysmogram display is selected a plethysmogram waveform is printed The printer stops automatically when the printout is complete Waveform Printouts start off with a Header refer to previous section A Capnogram Waveform Printout represents the ten seconds of capnogram data immediately prior to when the EVENT key was pressed Graphically the EVENT key press corresponds to the bottom of the printout the top of the printout is ten seconds before EVENT was pressed The time and ETCO CO SMO User s Manual 95 Section 13 Interpreting Printer Output Respiratory Rate and Inspired CO values are also printed The printed values reflect the monitor s display at the instant of printing NOVAMETRIX MEDICAL SYSTEMS INC COSMO ETCO2 Sp02 MONITOR PRINTED AT 14 18 Gd MAR 19993 Header 4 PATIENT NAME NOTES Printout M capbNoGRAM Identification tH Scale ETCO2 Parameters S8N0335 87 BZIBITPI C6617HBH 9E sdSNl M ZBTZaNH SHUWEPRaZODIS EVENT key pressed 96 co sMO User s Manual Rev 04 Interpreting Printer Output Using a Printer Rev 04 A Plethysmogram Waveform Printout represents the five seconds of plethysm
18. 5 Refer to the ThinkJet Owner s Manual for further printer details Print Formats The information output by the printers is the same However due to printer differences the format of the printed information will vary slightly between printers The following print types are available e Displayed Trend Printout e Tabular Mode Text Printout e Capnogram or Plethysmogram Waveform Printout e Zoom Trend Printout e Compressed Trend Printout Displayed Trend Printout To create a Displayed Trend Printout from the graphical or histogram trend display 1 Ensure the selected printer is connected and ready to print 2 Press the TRND key to display trend data 3 Press EXPAND to select the 12 hour 8 hour 2 hour or 30 minute trend display The start and stop times for the printed graph and histogram are approximately due to compression the same as those displayed on the monitor trend display when the printout is initiated 4 Press the NEXT key TREND OPTIONS appears Rev 04 CO SMO User s Manual 89 Section 13 Print Formats 5 Press PRNT PRINTOUT STARTED is displayed and printing starts The user can also press PRNT in the histogram display the printout will be the same The printer stops automatically when the printout is complete If PRNT is pressed again before the printout finishes PRINT IN PROGRESS appears Press STOP to terminate printing or press CONT continue to resume printing 6 TREND OPTIONS reappear
19. Adult pediatric finger Adult toe 4 Position the sensor so that the foam wrap does not extend over the spaces between the fingers or toes This ensures no light transmission through this space Treat foam wrap in accordance with hospital protocol for single patient use Check site regularly to ensure adequate circulation and proper sensor positioning 42 CO SMO User s Manual Rev 04 Adhesive Foam Wraps SpO2 Sensors Adhesive Foam Wraps Adhesive foam wraps are for use when applying the Novametrix Y Sensor catalog No 8793 or 8791 to adult pediatric or neonatal patients Select a foam wrap based on the patient type e Catalog No 6929 Large adult pediatric finger neonatal pediatric foot or hand e Catalog No 6968 Small neonatal foot or hand pediatric toe or finger To use the adhesive foam wrap 1 With the blue side of the foam wrap facing up press the buttons on the back of each Y sensor head through the holes in the foam wrap The wrap will stretch to fit the buttons The white side of foam should show two blue circles where the buttons were pushed through Head uw 4 Button d v PA Blue foam Cross section of sensor head C White fabric in the foam wrap Center strip removed If using the first and third holes on the foam wrap it may be necessary to cut the center strip off the Y sensor Y Sensor may be removed 2 Remove both sides o
20. Analog Module includes RS232 pass thru Transport Pouch for CO SMO Side Pouch for accessories included with monitor CAPNOSTAT CO Sensor Cable Holding Clips 50 per box Power Cord included with monitor Saturation Sensor Extension Cable 4 feet Saturation Sensor Extension Cable 6 feet Saturation Sensor Extension Cable 10 feet Saturation Sensor Extension Cable 25 feet Cable Serial Output to Personal Computer with 25 pin connector Cable Serial Output to Personal Computer with 9 pin connector Cable RS232 SARA SARAcap Interface Custom Cables Consult factory for specifications and pricing 120 co swo User s Manual Rev 04 CO2SMO Capnograph and Pulse Oximeter Accessories Catalog No 140030 140031 140032 140033 140034 140035 140036 140037 140038 140082 5758 81 5758 85 7167 82 8744 83 5779 00 9999 96 Rev 04 Description MOUNTING SYSTEMS Wall Mount Wall Mount less Wall Channel Pivot Block Mount Transport Mount without swivel head Transport Mount with swivel head Countertop Mount 11 inch Base Countertop Mount 5 inch Base Portable Instrument Housing Rollstand T Mount Bracket for Rollstand EXTENDED WARRANTY Normal warranty Monitor amp CAPNOSTAT CO Sensor 1 yr Finger Sensor 6 mo CO SMO Capnograph and Pulse Oximeter Model 7100 Total Warranty
21. CO SMO User s Manual 101 Section 14 NOVACOM1 Interface Mode 5 Dual Waveform In Dual Waveform mode the end tidal CO respiratory rate inspired CO values saturation values and respiration rate are continually transmitted at one second intervals To enter dual waveform mode the computer must send an ASCII 5 character The COSMO will echo the 5 followed by a lt cr gt lt 1f gt and then enable communication The data format is MS p yY S p x 7z or lf sent once a second c p lt cr gt lt l1f gt sent 48 times a second where Event Marker identifier M event marked no event E an identifier for the a 3 digit ASCII CO value to follow R an identifier for the 3 digit ASCII Resp rate value to follow I an identifier for the 2 digit ASCII Inspired CO value to follow Y an identifier for a 2 digit ASCII CO status message value S an identifier for a 3 digit ASCII SpO value to follow P an identifier for a 3 digit ASCII Pulse value to follow Z an identifier for a 2 digit ASCII SpO status message value a 3 digit ASCII value a 2 digit ASCII value c an identifier for a 2 digit waveform data point to follow a 2 digit ASCII value in the range 0 99 p an identifier for a 2 digit waveform data point to follow a 2 digit ASCII value in the range 0 99 cr lf acarriage return line feed sequence Mode 6 Trend
22. Cidex is a trademark of Arbook Inc COSMO User s Manual 111 Section 15 112 10 11 12 13 14 Maintenance Schedules Remove the syringe from the unit Do not connect the Sampling Inlet tubing Connect the line cord and turn the monitor on Allow the sampling pump to operate for several minutes This will help to remove any trapped water Connect a Sampling Tubing set to the Sampling Inlet Block the open end of the tubing with your finger Alternate blocking and unblocking the tubing end at least ten 10 times Use a quick brisk motion when blocking and unblocking the tubing Keep the tubing blocked and unblocked for several seconds at a time Repeat the same blocking and unblocking action with your finger on the Sampling Exhaust port Allow the Sampling System to run for at least 30 minutes without the Sampling Assembly tubing and the Sampling Exhaust tubing if any connected This will speed dry the system pneumatics Once these cleaning sterilization instructions have been completed normal Sampling System operation can be resumed See Sampling Airway Adapter on page 25 Maintenance Schedules When the monitor powers up a self test is performed which checks the internal electronics of the monitor If this self test fails remove the monitor from use and contact qualified service personnel The monitor should undergo routine inspection and safety checks on a quarterly basis or according to hospital protocol
23. Dump Trend data is transmitted as a succession of records The record size for CO SMO is 40 bytes of hexadecimal ASCII data A record can be one of two types an INFO record or a DATA record The INFO record contains monitor information such as time of day date limit settings and units The DATA record contains ETCO respiration rate inspired CO event marker audio disable SpO and pulse rate values The first record sent is always an INFO record This record reflects the oldest data in the buffer then records would continue being sent in chronological order from the oldest record to the newest record In normal monitoring use an INFO record would be followed by 15 data records followed by another INFO record and then another 15 data records etc Turning the monitor off or changing the limits will disrupt this sequence When this occurs a new INFO record will be sent and indicate the time and date along with the current limits At this point unless another exception occurs the next INFO record will be followed by 15 DATA records An INFO record can be distinguished from a DATA record by the first byte of the record The first byte of an INFO record is FF the first byte of a DATA record is 00 C8 0 200 decimal or FB pen lift or no data available Any other values are not applicable The DATA record uses 8 data points per parameter at 8 second resolution for a total of 64 seconds of trend data per data record To request trend
24. HbO 100 COHb METHb HbO Fractional Hemoglobin COHb Carboxyhemoglobin METHb Methemoglobin Functional Saturation Functional saturation represents the amount of oxyhemoglobin as a percentage of the hemoglobin that can be oxygenated Dysfunctional hemoglobins COHb and METHb are not included in the measurement of functional saturation Pulse Rate is calculated by measuring the time interval between the peaks of the infrared light waveform The inverse of this measurement is displayed as pulse rate COSMO must be used in conjunction with SuperBright saturation sensors An INCOMP SpO2 PROBE message indicates a non SuperBright Sensor is in use COSMO User s Manual Rev 04 Front Panel Controls and Connectors Introduction Front Panel Controls and Connectors ETCO RESP br min 87 bem HLET TRHD SCALE CAL MENU 1 Press to turn COSMO on or if on press to turn off ETCO portion of monitor Press in combination with W i to turn unit off 2 Press to turn CO SMO on or if on press to turn off SpO portion of monitor Press in combination with sse to turn unit off 3 ACON v If illuminated CO SMO is connected to AC Mains power and charging internal battery 4 LOW BAT gj Illuminates when approximately 15 minutes of battery life remain 5 e Two Minute Silence Illuminates when key is pressed Indicates audible alerts are silenced for two minutes 6 Press and release to start Two Min
25. Hz Indications and Usage The CO SMO ETCO Monitor Model 7100 is intended to be used for monitoring end tidal CO respiration rate functional oxygen saturation and pulse rate in all critical monitoring environments including ventilatory support patient transport and anesthesia CO SMO is designed to monitor all patients including adult pediatric and neonatal COSMO is not intended for any other purpose The following factors can influence CO measurement nitrous oxide elevated oxygen levels barometric pressure water vapor and halogenated agents For maximum patient and operator safety you must follow the following warnings and cautions Warnings WARNING Indicates a potentially harmful condition that can lead to personal injury e Explosion Hazard Do NOT use COSMO in the presence of flammable anesthetics Use of this instrument in such an environment may present an explosion hazard e Electrical Shock Hazard Always turn CO SMO off and remove the line cord before cleaning it Do NOT use a damaged sensor or one with exposed electrical contacts Refer servicing to qualified service personnel Failure of Operation If the monitor fails to respond as described do not use it until the situation has been corrected by qualified personnel e Do not operate CO SMO when it is wet due to spills or condensation e Do not operate COSMO if it appears to have been dropped or damaged e Keep COSMO and its accessories
26. Monitor 2 years CO5SMO Model 7100 with CAPNOSTAT CO Sensor Cat No 7167 Total Warranty Monitor 2 years CAPNOSTAT 2 years Finger Sensor Cat No 8744 1 year Additional 7167 when monitor is covered Total Warranty CAPNOSTAT CO Sensor 2 years Additional 8744 when monitor is covered Total Warranty Finger Sensor 2 years BIOMEDICAL TEST KIT Service Test Kits include items and materials qualified service personnel may require to determine the functional integrity and or accuracy of the system COSMO Service Test Kit Model 7100 Other kits available contact Novametrix Service Department Focus Technical Training Seminars For class schedules call 1 800 243 3444 Ext 2567 CO SMO User s Manual 121 Section 17 CO2SMO Capnograph and Pulse Oximeter This page intentionally blank 122 co swo User s Manual Rev 04 Section 18 Typical Capnogram Waveforms Normal Waveform The normal capnogram provides a waveform of changing levels of expired CO 50 mmHg Waveform evaluation e A B Ascending limb expiratory portion mixed deadspace and alveolar air with increasing concentration of CO Normally starts at a baseline of zero e B C Alveolar plateau contains mixed alveolar gas with End Tidal measured at C e C D Descending limb inspiratory portion with decreasing concentration of CO Normally returns to a baseline of zero Cardiogenic Oscillat
27. Novametrix obligations under this guarantee are limited to repairs or at Novametrix option replacement of any defective parts of our equipment except fuses batteries and calibration gasses without charge if said defects occur during normal service Claims for damages during shipment must be filed promptly with the transportation company All correspondence concerning the equipment must specify both the model name and number and the serial number as it appears on the equipment Improper use mishandling tampering with or operation of the equipment without following specific operating instructions will void this guarantee and release Novametrix from any further guarantee obligations Service Department For factory repair service call toll free 1 800 243 3444 In Connecticut call Collect 203 265 7701 Facsimile 203 284 0753 World Wide Web http www novametrix com Internet techline novametrix com Caution Federal U S A law restricts this device to sale distribution or use by or on the order of a licensed medical practitioner Copyright 1993 1998 Novametrix Medical Systems Inc This document contains information which is proprietary and the property of Novametrix Medical Systems Inc and may not be reproduced stored in a retrieval system translated transcribed or transmitted in any form or by any means without prior explicit written permission from Novametrix Medical Systems Inc COSMO Operator s Gu
28. STARTED C Sequentially selects each entry point Clears entire Patient ID field PRINT IN PROGRESS STOP CONT v bR STORINGTRENDTOCARD PLEASE WAT TERMINATING PRINTOUT CO SMO Menu Tree Revision 2 9 Software Page 2 of 4 This menu is displayed for approximately 8 seconds on power up if niether key is pressed the Main Menu will appear ERASE STORED TRENDS YES NO TRENDS RETAINED TRENDS ERASED Pressing the EVENT key while in the Main Menu EVENT MARKED XX XX Which NOVACARD Printer Interface Selected WAVEFORM FROZEN RUN If mains and battery power is removed from the main board when power is reapplied and the monitor is turned on this will appear for 3 seconds on power up WARNING CHECK TIME DATE Placing Capnostat on Zero Cell TIME REMAINING XX XX CANCEL When the pump is turned on in the SET SAM PLING PUMP menu CAL CO2 CANNULA will appear on the display Pressing the CAL key will produce the following menu sequence CO2 CANNULA ATTACHED CONT CANCEL PLACE ON ADAPT IN RM AIR START CANCEL A Vv PLACE ON REF CELL CANCEL v Placing Capnostat on Reference Cell after zero calibration v To WRITE To S CANNOT WRITE THIS CARD Edit Patient ID f
29. after connecting the selected printer and readying for printing and the displayed trend duration is graphically printed along with a histogram covering the same time frame See Using a Printer on page 85 Trend and NOVACARD Memory Module If NOVACARD INTERFACE is selected in the MONITOR OPTIONS 2 portion of the menu system a CARD key is displayed in the TREND OPTIONS menu Press the CARD key after connecting the NOVACARD MEMORY MODULE and installing a NOVACARD and the NOVACARD MENU will appear From this menu trend data can be stored to the memory card patient ID can be entered or changed or the NOVACARD can be erased See NOVACARD Memory Module User s Manual for more information CO SMO User s Manual 71 Section 9 Trend and NOVACARD Memory Module This page intentionally blank 72 COSMO User s Manual Rev 04 Rev 04 Section 10 Miscellaneous Features Bow ge Keyclick Volume CO5SMO can respond to each key press with an audible tone a keyclick assuring the user that the monitor recognized a key was pressed To alter the keyclick volume Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears Repeatedly press the NEXT key until MONITOR OPTIONS 1 appears Press KCLK keyclick KEYCLICK VOLUME appears The current keyclick volume setting 0 7 is displayed between the up and down arrows A 0 setting means the keyclick feature is turned off Press T or J to increase or decrease the
30. calibration Otherwise skip this step Adapter Calibration needs to be performed each time you switch airway adapter types for example if you switch from using an Adult to a Neonatal adapter but not if you switch from an Adult adapter to another Adult adapter Adapter Calibration should also be performed if the monitor displays ADAPTER CAL To perform an Adapter Calibration Rev 04 CO SMO User s Manual 17 Section A Adult Airway Adapter Press CAL PLACE ON ADPT IN RM AIR message appears Place the sensor and airway adapter away from all sources of CO including the patient s and your own exhaled breath and ventilator exhaust valves Press START TIME REMAINING counts down and the Main Menu reappears The actual calibration will take typically less than 15 seconds NOTE If the monitor detects changing CO levels breaths during an adapter calibration BREATHS DETECTED is displayed followed by PLACE ON ADPT IN RM AIR To continue remove the source of COs wait 30 seconds and press START 4 When using the Adult Airway Adapter place the CAPNOSTAT CO Sensor Airway Adapter assembly at the proximal end of the airway circuit between the elbow and the ventilator circuit wye Shown with CAPNOSTAT CO Sensor Cat No 7167 UMS may also use Cat No 7067 Cable Clip Cat No 8751 Adult Airway Adapter Cat No 7007 S ga To Patient e For optimal results do NOT place the a
31. feature can itself be disabled for use in situations where suppressing audible alerts is undesired e The Alert Bar stops flashing automatically if the parameter that caused a limit alert returns within its limits or the Alert Bar can instead be set to continue flashing until the user presses the key or the Alert Bar can be turned off altogether Limit Alerts COSMO provides audible and visible limit alerts for ETCO Respiratory Rate SpO and Pulse Rate Each parameter has separate alert limits Limit Alerts are audible and visible signals generated by the CO SMO in response to parameter values that violate the Alert Limits Alert Limits are the maximum and minimum allowable values for each parameter CAUTION The Limit Alert functions described below assume that the CO SMO is using factory default alert parameters You may experience other results if you are not using the default settings Refer especially to Limit Alerts Delayed Instant on page 65 If ETCO Respiratory Rate SpO or Pulse Rate violates an alert limit setting e The red A bell shaped indicator next to the key starts to flash Rev 04 CO SMO User s Manual 59 Section 8 Auto Alert Limits An f or up or down arrow indicator starts to flash beside the violated parameter s display The arrow direction indicates a High or Low Limit Alert If the parameter returns within its limits before 10 seconds elapse the J and ft or i
32. flashes 3 Press ON or OFF as desired ON Turn on Respiratory Rate Editor on OFF Turn the Respiratory Rate Editor off 4 Press RUN to return to the Main Menu Capnogram CO5SMO displays a capnogram a graphic representation of the concentration of CO as a function of time The user can change the speed at which the capnogram is drawn across the display The user can also change the capnogram s vertical scale Capnogram Scale half Capnogram br ALET TRHD SCALE CAL MEHU Capnogram Speed To change the capnogram s sweep speed 1 Press the SCALE key CAPNOGRAM CONTROLS appears If necessary press to display both the capnogram and the SCALE key 2 Press the mm s key SWEEP SPEED mm sec appears The current setting flashes 3 Select the 6 5 13 or 26 mm sec as desired At 6 5 mm sec the capnogram show approximately 12 seconds of data At 13 mm sec the capnogram shows approximately 6 seconds of data At 26 mm sec the capnogram shows approximately 3 seconds of data 4 Press RUN to return to the Main Menu Rev 04 CO SMO User s Manual 35 Section 5 Capnogram Capnogram Scale To change the capnogram s vertical scale 1 Press the SCALE key CAPNOGRAM CONTROLS appears If necessary press to display both the capnogram and the SCALE key 2 Press the SCALE key The capnogram s vertical scale toggles from 0 50 to 0 75 to 0 100 mmHg with each keypress 3 Press RUN to return to the Main Menu Selecting
33. is standard COSMO ETCO SpO Monitor Model 7100 with CAPNOSTAT CO Sensor Cat No 7167 and OxySnap M SuperBright Finger Sensor Cat No 8744 CAPNOSTAT CO SENSOR CAPNOSTAT CO Sensor with Adult Airway Adapter Cat No 7007 and 5 ea Sensor Cable Holding Clips Cat No 8751 AIRWAY ADAPTERS Adult Airway Adapters 10 per box Neonatal Airway Adapters 10 per box Sampling Airway Adapters with tubing 1 per box Sampling Airway Adapters with tubing 3 per box Sampling Airway Adapters with tubing 5 per box Sampling Adapters with tubing 10 per box Pediatric Adult Single Patient Use Airway Adapters 10 per box Pediatric Adult Single Patient Use Airway Adapters 25 per box Pediatric Adult Single Patient Use Airway Adapters with mouthpiece 10 per box CO SMO User s Manual 117 Section 17 Catalog No 6421 25 6312 00 6312 25 8781 8780 8906 8907 8908 8909 6455 00 6455 25 6480 00 6480 25 8933 00 8936 00 8793 8744 8853 8898 CO2SMO Capnograph and Pulse Oximeter Description Pediatric Adult Single Patient Use Airway Adapters with mouthpiece 25 per box Neonatal Pediatric Single Patient Use Airway Adapters 10 per box Neonatal Pediatric Single Patient Use Airway Adapters 25 per box SINGLE PATIENT USE AIRWAY ACCESSORIES Nasal CO Sampling Cannula Adult 10 per box Nasal CO Sampling Cannula Pedi
34. keyclick volume setting Each key press will cause a keyclick tone to sound Press RUN to return to the Main Menu Display Brightness CO SMO has two user selectable display brightness settings To select a display brightness setting Press the MENU key CO2 OPTIONS appears Press the NEXT key SYSTEM OPTIONS appears Press the LITE key to switch the backlight between its bright and dim settings Press RUN to return to the Main Menu Display Colors The default CO SMO display white text on a blue background and a blue wave over a white background can be changed This display colors feature coupled with the bright and dim backlight settings allows COSMO to provide a very visible display over a wide range of lighting conditions To change the display colors Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears Repeatedly press the NEXT key until MONITOR OPTIONS 1 appears CO SMO User s Manual T3 Section 10 Setting the Clock Calendar 3 Press DISP display and the display colors are inverted The two display modes are White text on blue background with a blue wave on white background default and blue text on a white background with a white wave on a blue background 4 When the display is as desired press RUN to return to the Main Menu Setting the Clock Calendar COSMO contains a clock calendar feature that operates even when the monitor is turned off This feature allows COSMO to time stamp
35. monitoring while trends are displayed Any latched alert that occurs while viewing trend data causes the Main Menu to reappear Also if no keys are pressed for 5 minutes the Main Menu replaces the trend display Graphical Trend Display To display trend memory Press the TRND key DRAWING TREND PLEASE WAIT is briefly displayed The most recent 12 hours of ETCO or SpO data is then graphically displayed NOTE If the capnogram or dual waveform is displayed when TRND is pressed an ETCO trend is drawn If the plethysmogram waveform is displayed an SpO trend is drawn Press the Ej key to switch between ETCO and respiratory rate and SpO and pulse rate trend displays CO SMO User s Manual 67 Section 9 a Graphical Trend Display New trend data is continually collected The display is redrawn each time you exit and enter the trend display mode New data enters the graph from the right pushing older already displayed data towards the left If less than 12 hours of data have been collected the graph will be shortened accordingly Dotted vertical lines indicate times when the monitor was turned off The flashing dashed vertical line in the trend is called the cursor la Press the lt arrow left key to move the cursor towards older data 1b Press the gt arrow right key to move the cursor towards more recent data Information displayed in the status line above the graph is specific to
36. off Press PREV as necessary to return to the base trend display Dual SpO and Pulse Rate Trend Display Scales The dual SpO and Pulse Rate trend display scales but not the SpO only trend display scale can be changed To change the Dual SpO and or Pulse Rate graphical trend display scales Press the TRND key Wait for the SpO trend to be displayed If necessary press the key to ensure the SpO trend is displayed Press the NEXT key TREND OPTIONS appears Press VIEW TREND VIEW appears Press DUAL The dual trend appears and TREND OPTIONS is displayed skip if DUAL is already selected Press VIEW TREND VIEW appears skip if DUAL is already selected Press SCAL scale TREND SCALE appears Press SpO2 or PULSE as desired Press SpO2 to change the SpO trend display scale Press PULSE to change the Pulse Rate display scale Press HALF or FULL as desired HALF Selects 80 100 for SpO or 50 150 beats min for Pulse Rate FULL Selects 60 100 for SpO or 50 250 beats min for Pulse Rate Press PREV as necessary to return to the base trend display These settings are retained even when the monitor is turned off CO SMO User s Manual 69 Section 9 Histogram Trend Display Histogram Trend Display Histogram displays provide a neatly tabulated and easily interpreted summary of ETCO and Respiratory Rate or SpO and Pulse Rate trend memory data CO5SMO s histogram display reflects the currently selected gr
37. or sterilize the adapter as system performance may be compromised 1 Remove the adapter from the package Verify the adapter is intact 2 Snap the Single Patient Use airway adapter into the CAPNOSTAT CO Sensor It will click into place when properly seated 3 Perform an adapter calibration Adapter Calibration needs to be performed each time you switch airway adapter types for example if you switch from using a Neonatal to a Single Patient Use Adult adapter but not if you switch from one Single Patient Use Adult adapter to another Single Patient Use Adult adapter Adapter Calibration should also be performed if the monitor displays ADAPTER CAL To perform an Adapter Calibration Press CAL PLACE ON ADPT IN RM AIR message appears Place the sensor and airway adapter away from all sources of CO including the patient s and your own exhaled breath and ventilator exhaust valves Press START TIME REMAINING counts down and the Main Menu reappears The actual calibration will take typically less than 15 seconds NOTE If the monitor detects changing CO levels breaths during an adapter calibration BREATHS DETECTED is displayed followed by PLACE ON ADPT IN RM AIR To continue remove the source of COs wait 30 seconds and press START Rev 04 CO SMO User s Manual 19 Section A Single Patient Use Airway Adapter with Mouthpiece 4 Install the CAPNOSTAT CO Sensor Airway Adapter assem
38. s Manual Rev 04 Section 3 Monitor Power Up This section explains how to turn the CO SMO on and off It also explains AC Mains and battery power operation Monitor Power Up 1 Verify CAPNOSTAT CO and SpO Sensor integrity Ensure sensors and their extension cables are physically intact with no broken frayed or damaged components 2 Plug the CAPNOSTAT CO Sensor into the front panel input connector CAUTION l Connect only a Novametrix Catalog No 7067 or 7167 CAPNOSTAT CO Sensors to COSMO Do not use other CO sensors with the CO SMO 3 Plug an SpO sensor or extension cable into the rear panel input connector Connect only Novametrix SuperBright SpO sensors to the COSMO Do not use other SpOs sensors with CO SMO 4 To turn CO SMO on press either the Or key Ensure all displays and indicators illuminate briefly Ensure a beep sounds to indicate that the audio is working Verify a Self Test in progress appears followed by the main menu COSMO powers up as a combined ETCO SpO monitor If only the capnograph or pulse oximeter portion is going to be used the unused half can be disabled to avoid nuisance alerts and error messages With the monitor turned on press either power key to shut down that half of the monitor Press the key again turn that half back on 5 Press the contrast key to adjust the display for optimum viewing 6 Press YES to erase or press NO to reta
39. sampling pump This may cause accelerated wear on the pump bearings Always flush liquids with a syringe as described in the following instructions To clean sterilize the pumping system Turn the monitor off and disconnect the line cord Remove both the Sampling Inlet tubing set and the Sampling Exhaust tubing if any Attach an exhaust port line 1 8 inch or 3 16 inch I D tubing from the Sampling Exhaust port to a suitable container located below the bottom level of the monitor Use a 60 cc catheter tip syringe Fit it to the Sampling Inlet connector Flush the sterilizing solution slowly through the pumping system Push the entire 60 cc of solution through the Sampling Inlet Repeat this process two 2 more times a total of 180 cc of solution Remove the syringe and leave the cleaning sterilizing fluid within the sampling pump system for 30 minutes This will disinfect Follow sterilant manufacturers instructions for sterilization times After 30 minutes fill the syringe with distilled water and flush the system three 3 times Allow the cleaning sterilization solution and distilled water to drain through the Sampling Exhaust output Push several syringes of air slowly through the system to ensure that most of the liquid has been drained Follow this with at least three 3 more pushes of distilled water followed by at least two 2 more pushes of air to ensure that most of the distilled water has been drained
40. seconds the parameter returns within its limits the alert is cancelled The 10 second audible and Alert Bar delay can be eliminated if the user desires the monitor activate audible and Alert Bar alerts as soon as an alert limit is violated Eliminating the delay also has the effect of latching the alert as soon as it occurs See Limit Alerts Latched Unlatched on page 64 To select or eliminate the 10 second audible and Alert Bar delay for limit alerts Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS is displayed Repeatedly press the NEXT key until ALERT OPTIONS 2 appears Press DELAY and 10 SEC LIMIT ALERT DELAY appears The current setting flashes Press YES or NO as desired YES Audible and Alert Bar alerts for violated alert limits are delayed 10 seconds NO Audible and Alert Bar alerts occur as soon as an alert limit is violated CAUTION Once the Alert Delay setting is selected that choice remains in effect even if the monitor is turned off and on until changed by the user ALERT OPTIONS 2 reappears Press RUN to return to the Main Menu CO SMO User s Manual 65 Section 8 Alert Bar Latched Unlatched Off Alert Bar Latched Unlatched Off The Alert Bar to the right of the monitor display can be set to operate in three different modes The Alert Bar can be Latched Unlatched or turned off altogether A Latched Alert Bar starts to flash as soon as a limit alert occurs If the
41. that it is oriented correctly Press the fuse housing back into the power entry module 7 Close the fuse access door and verify that the proper mains operating voltage is displayed Line operating voltage 114 co swo User s Manual Rev 04 Section 16 Specifications General Specifications for the Novametrix CO SMO ETCO SpO Monitor Model 7100 are listed for informational purposes only and are subject to change without notice Capnograph Principle of Operation Non Dispersive Infrared NDIR absorption dual wavelength ratiometric True Single Beam Optics e Sensor Type Mainstream system eliminates the need for and cost of sample lines water traps and waste gas scavenging e Warm up Time Operational in 30 seconds 20 minutes to full specification e Response Time Less than 75 ms e Calibration Simple one step calibration less than 20 seconds Oj N50 Compensation Operator selectable e Barometric Pressure Compensation Automatic and manual over ride range 550 780 mmHg e CAPNOSTAT CO Sensor and Airway Adapter Weight Less than 2 oz 57 grams without cable Sensor Size 1 3 4 x 1 1 2 x 3 4 inches 10 foot cable 4 45 x 3 81 x 1 91 cm 3 05 m cable Construction Durable high performance plastic ultra flexible cable Shock Resistant Sensor will withstand a 6 foot drop to a tile floor e Airway Adapter Disposable or reusable less than 5 cc deadspace meets ANSI Z 79 e End Tidal CO Range
42. the AUDIO key while the Allow Audio Off portion of the Options Menu is set to No NOVAMETRIX MEDICAL SYSTEMS INC COSMO SELF TEST IN PROGRESS Monitor is performing power up system diagnostic tests that check the system RAM and ROM If a failure in testing RAM is encountered the monitor will flash three front panel LEDs If a failure in ROM is encountered the two outer LEDs will flash the monitor will not function in either case PARAMETERS RESET TO FACTORY DEFAULTS Displayed when monitor is turned on while pressing the ALERT RESET key Monitor is now using factory default settings This message will also appear if new software has been installed The monitor will perform a self test and check the RAM and ROM then reset to the factory default settings BATTERY VERY LOW PLUG IN AC POWER Monitor is running on battery power and the battery power has been depleted Connect line cord to AC Mains power source and set the rear panel switch to P Monitor s rear panel fuse has blown monitor switched over to battery power and has depleted battery life WARNING CHECK TIME DATE Displayed for approximately two seconds on power up if both AC mains and battery power are removed from the main board Set proper Time Date to eliminate message from appearing on power up CO SMO User s Manual 83 Section 12 This page intentionally blank 84 co sMO User s Manual Rev 04 Section 13 Using a Pr
43. the Instantaneous CO Mode In the instantaneous CO mode the instantaneous CO value will be displayed and OFF icons will appear in the ETCO and Respiration limits screen section This indicates that the ETCO alert limits and the respiration alert limits are not active while in the instantaneous mode When in instantaneous mode the Respiration display will show INST When this option is selected the Respiration value will not be shown the Respiratory Interval Alert Timer timer will also be disabled See Respiratory Interval Alert on page 33 To select the instantaneous CO mode 1 From the Main Menu press MENU When the CO2 OPTIONS screen appears press NEXT From the SYSTEM OPTIONS menu press AVG From the AVERAGING SELECTIONS screen press CO2 The SELECT ETCO2 AVERAGING screen will appear Press INST the monitor will return to the previous menu AVERAGING SELECTIONS Selecting INST will activate the Instantaneous mode INST will appear in the respiration field and both respiration and ETCO limit alert will be deactivated Alert disabled icons will appear in the upper corners of the ETCO screen section Ud Oe 2 Selection of 1BR Single Breath 10s or 20s will select the ETCO mode and use the selected averaging time The currently set alert limits will still be active unless the respiration alerts were deactivated in the SET ALERT LIMITS screen Monitors with software version 2 8 or newer have the Instantaneous C
44. the lower alert limit is set to 24 32 25 32 x 0 75 24 If the average ETCO value was 45 mmHg the upper limit would be set to 55 45 10 55 and the lower limit would be set to 35 45 10 35 Respiratory Rate Auto Alert Limits The respiratory rate auto alert limits are derived from the average of the three most recent respiratory rate values recorded before AUTO was selected The average then falls into one of three ranges that define the high and low limits Those ranges are Respiration High Low Rate Average Limit Limit 1 15 t 7 br min 5096 of value 16 40 10 br min 7 br min gt 40 15 br min 10 br min For example if the average of the three most recent respiration rate values recorded before AUTO was pushed was 28 br min the upper alert limit is set to 38 28 10 38 and the lower alert limit is set to 21 28 7 21 If the average respiratory rate is 12 br min the upper limit would be set to 19 12 7 19 and the lower limit would be set to 6 12 50 12 x 0 50 6 SpO gt Auto Alert Limits The SpO high auto alert limit is set to 5 more than the SpO value displayed when the AUTO was pressed maximum setting 2100 The low auto alert limit is set to 5 less than the SpO value displayed when AUTO was pressed minimum setting 50 Rev 04 CO SMO User s Manual 61 Section 8 Setting Alert Limits Manually For example if the SpO 98 when AUTO is pushed the system will
45. wye Shown with CAPNOSTAT CO Sensor Cat No 7167 may also use Cat No 7067 To Patient Wye Neonatal Airway Adapter Cat No 7053 NOTE e For optimal results do NOT place the airway adapter between the ET tube and the elbow as this may allow patient secretions to block the adapter windows Position the Airway Adapter with its windows in a vertical and NOT a horizontal position This helps keep patient secretions from pooling on the windows If pooling does occur the airway adapter may be removed from the circuit rinsed with water and reinserted into the circuit e To prevent rain out and moisture from draining into the Airway Adapter do NOT place the Airway Adapter in a gravity dependent position 5 Check the connections have been made correctly by verifying a proper CO waveform capnogram on the monitor display 22 CO 5MO User s Manual Rev 04 Single Patient Use Neonatal Airway Adapter CAPNOSTAT CO Sensor 6 The sensor cable should face away from the patient 7 See Monitoring CO and Respiratory Rate on page 29 Single Patient Use Neonatal Airway Adapter The single patient use Neonatal Airway Adapter Catalog No 6312 should be used when monitoring intubated patients with an ET tube size of 4 0 or smaller with Novametrix CAPNOSTAT mainstream CO sensors Catalog No 7167 Deadspace The added deadspace due to the presence of the adapter is less than 5 cc CAUTIO
46. 0 6066 07 6068 07 600048 600049 6064 81 9622 7106 10 7104 10 8751 600026 4941 4942 4943 5266 5334 5335 4832 CO2SMO Capnograph and Pulse Oximeter Description Cable to Seiko DPU 414 Printer 9 to 9 pin Model 610 Cable to Hewlett Packard ThinkJet Printer Hewlett Packard ThinkJet Printer Ink Cartridge Hewlett Packard ThinkJet Printer Paper 2500 sheets Z fold Seiko DPU 414 411 Thermal Printer Paper 5 rolls per box Seiko Battery Pack AC Adapter 120 VAC AC Adapter 100 VAC AC Adapter 230 VAC ACCESSORIES NovaCARD Startup Kit includes 1 each Writer module Reader module SRAM Memory Card 128k and NovaCARD for MS DOS software NovaCARD Computer Archive Recall and Display is a hardware software combination that allows users to transfer patient trend data user stored waveforms and monitored parameter values from supported Novametrix monitors to a personal computer NovaCARD Writer Module connects to Novametrix monitor NovaCARD Reader Module includes power supply and cable to PC serial port NovaCARD for Windows 3 2 disk and RTU license NovaCARD for MS DOS 3 2 disk and RTU license SRAM Memory Card 128k byte Cable connects NovaCARD Reader to PC 6 ft Cable PC Serial Port adapter 25 to 9 pin 1 ft NovaCARD warranty extended an additional 1 year at time of purchase hardware only SRAM cards not included
47. 0 100 mmHg CO2 partial pressure Accuracy 0 40 mmHg 2 mmHg 41 100 mmHg 5 of reading Stability 2 mmHg Display Resolution 0 50 mmHg scale 0 9 mmHg 0 75 mmHg scale 0 6 mmHg e Respiratory Rate Range 0 150 br min Accuracy 1 br min 1 Monitors with version 1 9 software do not have automatic barometric pressure compensation pressure compensation is manually selectable from 550 780 mmHg Monitors with version 1 9 software are identified by an L in the serial number suffix Rev 04 CO SMO User s Manual 115 Section 16 Oximeter Oximeter e Oxygen Saturation Range 0 100 Accuracy 80 100 2 0 79 unspecified Approximately 68 of the observations are within the accuracy claim Display Resolution 1 Averaging Time Menu selectable 2 or 8 seconds e Pulse Rate Range 30 250 beats per minute bpm Accuracy 1 of full scale Approximately 68 of the observations are within the accuracy claim Display Resolution 1 bpm Averaging Time fixed at 8 seconds Monitor Specifications e Operating Environment 50 104 F 10 40 C 0 90 relative humidity non condensing e Size Height 3 3 in 8 38 cm Width 9 in 22 86 cm Depth 8 in 20 32 cm e Weight 8 pounds 3 63 kg e Power 100 120 200 240 VAC 50 60 Hz 40V A e Fuse Rating 100 120 VAC 0 5 A 250 V Slo Blo x2 200 240 VAC T 250 mA 250 V x2 e Battery Lead acid gel cell 2 hour life on screen life indicator recharge 12 hours e Display SuperBright
48. 20 bpm IABP ratio 1 3 then displayed Pulse Rate should be 120 120 3 160 beats min Since while in IABP Mode the pulse rate display will be affected by motion or other artifact the accuracy of the Pulse Rate display can usually be used as an indicator of the quality of the SpO display Even if IABP Mode is on VERY poor sensor signals activate the Display Held Timer if enabled SpO limit alerts function as usual while IABP Mode is turned on Pulse Rate limits also function as usual while IABP Mode is turned on CO SMO User s Manual 57 Section 7 IABP Mode This page intentionally blank 58 CO SMO User s Manual Rev 04 Section 8 Alerts Overview COSMO provides several alert options e Alert limits can be adjusted automatically with the Auto Alerts feature or manually from within the menu system e Limit alerts require user action to be reset they can also be configured to automatically reset e Alert limit settings are retained in memory and restored each time the monitor is turned on the monitor can also be set to power up each time using default settings Audible alerts are delayed 10 seconds from the occurrence of a limit alert the delay can also be eliminated to allow instant activation e Audible alert volume can be adjusted Audible alerts can be temporarily silenced for two minutes Audible alerts can be suppressed altogether via the Audio Off feature Furthermore the Audio Off
49. 3 Gently squeeze the end of the ear clip shown in diagram and apply the sensor to the patient If a satisfactory reading cannot be obtained rub the site and or use adhesive dots for better response The adhesive dots PN 8700 00 included with the ear clips will also help in preventing the ear clip from falling off e g during exercising Adult Ear Optional placements Rev 04 CO SMO User s Manual 45 Section 6 Single Patient Use SpO Sensors WARNING Inspect the site often for adequate circulation at least once every four hours When applying sensors take note of patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate Y Sensor Quick Check 1 With the Y Sensor connected to monitor but not applied to patient position the sensor heads so that they face each other the red light shines at the detector Is SpO2 PROBE OFF PT patient displayed Tape the Y Sensor to your index finger Does the monitor shows reasonable SpO and pulse rate values 3 AYES to BOTH 1 and 2 indicates the sensor is OK Apply the sensor to the patient as instructed above Single Patient Use SpO Sensors Intended Use The Single Patient Use SpO sensors Catalog No 6480 and 6455 can be used when monitoring adult pediatric or neonatal patients with Novametrix Pulse Oximeters S
50. 3 436 5 190 038 5 206 511 5 251 121 5 369 277 5 398 680 CO SMO User s Manual 47 Section 6 Single Patient Use SpO Sensors 2 Press the white connector on the end of the extension cable into the gray connector on the end of the Single Patient Use sensor Close the locking clip until it snaps around the sensor cable DB 9 Connector on extension cable Locking clip Sensor Connector 3 To disconnect the DB 9 extension cable from the sensor open the locking clip grasp the connectors and pull them apart To disconnect the DB 9 connector from the CO SMO press the latch release lever on the extension cable connector and pull the connector straight back away from the monitor DO NOT twist the connector PRESS DOWN ON LATCH RELEASE i THEN PULL OUT EMB IO UL 48 cO sMO User s Manual Rev 04 Single Patient Use SpOs Sensors SpO2 Sensors Sensor Application 4 Select the appropriate size sensor based on the patient type PEDIATRIC ADULT SENSOR Adult toe Adult finger NEONATAL PEDIATRIC SENSOR 27 Neonatal hand Gr Neonatal foot Pediatric toe 5 To apply the sensor place the blue side of the sensor wrap against the skin wrap it around the site and secure with Velcro tab If necessary cut the excess foam from the neonatal pediatric sensor before applying the Velcro tab then reattach the tab and secure the sensor Cut excess off d Velcro tab Neonatal
51. 5 hours If the monitor continues operating on battery power while in the low battery state Bi indicator flashing the message BATTERY VERY LOW PLUG IN AC POWER is displayed If the monitor is allowed to continue operation while in the very low battery state the monitor shuts itself off to prevent damage to the battery and monitor GI bem OJALET TEND SCALE CAL MENU This alert cannot be silenced by pressing the Les key The monitor must be connected to AC Mains power to silence the alert condition and recharge the battery See AC Mains Operation on page 6 AUDIO Key Audible alarms can be silenced in two ways temporarily or permanently e Two Minute Alarm Silence Press the key The e two minute silence indicator illuminates and audible alerts are silenced for two minutes After two minutes the indicator turns off and audible alerts are again allowed to sound To cancel the two minute silence before the two minutes have elapsed press the key again and the silence condition will be cancelled e Permanent Audio Off Press and hold the key until the O audio off indicator starts flashing No audible alerts will be generated To cancel the audio off condition press the key again it will stop flashing and audible alerts are again allowed to sound ALERT RESET Key An alert occurs if ETCO respiration rate SpO or pulse rate exceeds the displayed alert limits Alerts are also generated by conditions such
52. APNOSTAT CO Sensor onto the airway adapter It will click into place when properly seated The CAPNOSTAT CO Sensor cable should be facing away from the mouthpiece Direction of sensor cable CAPNOSTAT CO Sensor Mouthpiece To patient 3 Perform an airway zero only if prompted by the monitor An airway zero is not needed if a single patient use adapter had previously been used An airway zero should be performed only if the monitor displays ADAPTER CAL To perform an airway zero 3a Press CAL PLACE ON ADPT IN RM AIR message appears 3b Place the sensor and airway adapter away from all sources of CO including the patient s and your own exhaled breath and ventilator exhaust valves 3c Press START TIME REMAINING counts down and the Main Menu reappears The actual airway zero will typically take less than 15 seconds If the monitor detects changing CO levels breaths during an airway zero BREATHS DETECTED is displayed followed by PLACE ADPT IN RM AIR To continue remove the source of the CO wait 30 seconds and press START 4 Patient should seal mouth completely around the mouthpiece then breathe normally Neonatal Airway Adapter The Neonatal Airway Adapter Catalog No 7053 should be used when monitoring patients with Endotracheal Tube diameters less than or equal to 4 0 mm 1 Verify the windows are clean and dry Clean or replace the adapter if necessary 2 Snap the airway
53. CO SMO ETCQ SpO gt Monitor Model 7100 May 1 1998 Catalog No 5758 23 04 Novametrix Medical Systems Inc 5 Technology Drive Wallingford Connecticut U S A 06492 Copyright 1993 1998 All rights reserved No part of this manual may be reproduced without the written permission of Novametrix Medical Systems Inc Rev 04 Revision History 23 Jul 93 27 Apr 93 18 Jun 93 21 Sep 94 01 May 98 Revision 00 Revision 01 this manual is based on software version 2 1 Revision 02 DN N1247 Revision 03 Includes versions 1 9 and 2 8 software Disposable Adult Airway Adapter and CAPNOSTAT III references Revision 04 R N563 Declaration of Conformity with European Union Directive The authorized representative for Novametrix Equipment is D R M Green European Compliance Services Limited Oakdene House Oak Road Watchfield Swindon Wilts SN 6 8TD United Kingdom CO SMO Operator s Guide lil This page intentionally blank iv COSMO Operator s Guide Rev 04 Rev 04 Guarantee Equipment manufactured or distributed by Novametrix Medical Systems Inc is fully guaranteed covering materials and workmanship for a period of one year from the date of shipment except for certain disposable products and products with stated guarantees other than one year Novametrix reserves the right to perform guarantee service s at its factory at an authorized repair station or at the customer s installation
54. ECT PRINT MODE appears 4 Press TREND PRINT TREND appears 5 Press ALL SELECT TREND COMPRESSION appears 6 Select NONE 1 2 1 4 or PAGE NONE Printout length of up to 12 sheets of paper standard 8 5 x 11 inch sheets 1 2 Printout length of up to 6 sheets of paper 1 4 Printout length of up to 3 sheets of paper PAGE Printout sized to fit a single sheet of paper 7 PRINTOUT STARTED is displayed and printing starts If the capnogram or dual waveform display is selected ETCO and Respiratory Rate data is printed if the plethysmogram display is selected SpO and Pulse Rate data is printed The printer stops automatically when the printout is complete If PRNT is pressed again before the printout finishes PRINT IN PROGRESS appears Press STOP to terminate printing or press CONT continue to resume printing Rev 04 CO SMO User s Manual 91 Section 13 Interpreting Printer Output Interpreting Printer Output Header Each printout starts with a header that identifies the monitor COSMO ETCO SpO Monitor The date and time of the printout is furnished by the monitor s calendar clock Space is then provided to enter patient information The type of printout Zoom Compressed etc is then identified NOVAMETRIX MEDICAL SYSTEMS INC COSMO ETCO2 SPO2 MONITOR Header PRINTED AT 89 53 89 MAR 1993 PATIENT NAME NOTES Column E Printout A and B COL A AUDIO STATUS
55. EFORM TO CARD prompt appears when the EVENT key is pressed and the waveform is frozen Connecting the NOVACARD Module The CO SMO must be configured for NOVACARD Interface to operate with the NOVACARD Memory Module See Selecting NOVACARD Interface on page 107 1 Connect the NOVACARD Memory Module to the monitor s rear panel RS232 connector 2 Tighten the two spring loaded screws that secure the module to the rear panel Ensure that there are no cards inserted at this time to allow access to the spring loaded mounting screws Selecting TeleCap Interface To select the Telecap Interface for the CO SMO 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTIONS 2 appears 3 Press the SER serial interface key and the currently selected interface appears Available interfaces include INTERFACE UNUSED PRINTER INTERFACE NOVACOMI INTERFACE ANALOG MODULE INTERFACE MEMORY CARD INTERFACE TELECAP INTERFACE and TELESAT INTERFACE Rev 04 CO SMO User s Manual 107 Section 14 Selecting TeleSat Interface 4 Press PREV previous or NEXT to select TELECAP INTERFACE The Telecap interface is now selected for the CO SMO 3 Press RUN to return to the Main Menu Selecting TeleSat Interface To select the TeleSat Interface for the CO2SMO 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTION
56. EXT key TREND OPTIONS appears Press VIEW TREND VIEW appears Press DUAL or ETCO2 if ETCO displayed or SpO2 if SpO displayed as desired Press DUAL to display both ETCO and Respiratory Rate or SpO and Pulse Rate trends Press ETCO2 to display only ETCO trend data Press SpO2 to display only SpO trend data WARNING When the dual trend display is selected the monitor will retain this selection even when the trend display is exited and the monitor is turned off 68 co sMO User s Manual Rev 04 Graphical Trend Display Trend Memory Display Rev 04 ir du nod E ETCO and Respiratory Rate Trend Display Scales The ETCO only and ETCO and Respiratory Rate trend display scales can be changed To change the ETCO and or Respiratory Rate graphical trend display scales Press the TRND key Wait for the ETCO trend to be displayed If necessary press the key to ensure the ETCO trend is displayed Press the NEXT key TREND OPTIONS appears Press VIEW TREND VIEW appears Press SCAL scale TREND SCALE appears Press CO2 or RESP as desired Press CO2 to change the ETCO trend display scale Press RESP to change the Respiratory Rate display scale Press HALF or FULL as desired HALF Selects 0 50 mmHg for ETCO or 0 75 br min for Respiratory Rate FULL Selects 0 100 mmHg for ETCO or 0 150 br min for Respiratory Rate The selected parameter is retained in memory even when the monitor is turned
57. Menu Press PREV to return to MONITOR OPTIONS 2 menu 106 co swo User s Manual Rev 04 The NOVACARD Memory Module External Devices The NOVACARD Memory Module The CO5SMO can store patient trend information and waveforms into a memory card through the use of the NOVACARD Memory Module The NOVACARD Memory Module connects to CO SMO s rear panel RS232 connector see Selecting NOVACARD Interface on page 107 The information stored in the memory card can then be read by a computer using the VOVACARD Reader For more information on the NOVACARD Memory Module reference NOVACARD Memory Module Operator s Manual Cat No 5962 23 For more information on the NOVACARD Reader reference NOVACARD Reader Operator s Manual Cat No 6062 23 Selecting NOVACARD Interface To configure the COSMO to operate with the VOVACARD Memory Module 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTIONS 2 appears 3 Press the SER serial interface key and the currently selected interface appears Available interfaces include INTERFACE UNUSED PRINTER INTERFACE NOVACOMI INTERFACE ANALOG MODULE INTERFACE NOVA CARD INTERFACE TELECAP INTERFACE and TELESAT INTERFACE 4 Press PREV previous or NEXT to select NOVACARD INTERFACE 5 Press RUN to return to the Main Menu When NOVACARD Interface is selected a CARD softkey is added to the SYSTEM OPTIONS menu A STORE WAV
58. Muscle Relaxants aee ern eere nep REUS ID RP RIS 125 viii 125 Obstruction in Breathing Circuit or Airway oo eee sese ener nennen nens 126 Endotracheal Tube Kinked sde te ertet eee eee hee ette teet ep oen 126 Inadequate Seal Around Endothracheal Tube seen 127 Endotracheal Tube in Esophagus esses enne nennen nnne nee nenen nnne ene 127 Faulty Ventilator Circuit Valve 1 eee eee tirer iE eee pli repere pe 127 COSMO User s Manual Xi Xii CO SMO User s Manual Rev 04 About This Manual The COSMO ETCO SpO Monitor User s Manual describes the operation and use of the Novametrix CO SMO ETCO SpO Monitor Model 7100 The manual is divided into the sections described below Introduction on page 3 provides descriptions of the monitor its controls connectors and displays Patient Safety on page 11 lists important safety information including indications and usage warnings and cautions Monitor Power Up on page 15 explains how to turn COSMO on and off AC Mains operation and Battery operation are also explained here CAPNOSTAT CO Sensor on page 17 describes the CO sensor associated airway adapters and other accessories Monitoring CO and Respiratory Rate on page 29 describes those monitor features directly related to monitoring ETCO and Respiratory Rate SpO2 Sensors on page 37 describes the Finger Sensor the Y Sensor an
59. N The neonatal airway adapter is intended for single patient use Do not re use or sterilize the adapter as system performance will be compromised Instructions for Use 1 Verify that the airway adapter is intact 2 Align the arrow on the airway adapter with the arrow on the CAPNOSTAT CO Sensor and press together It will click into place when properly seated 3 Perform an airway zero only if prompted by the monitor An airway zero is not needed if a single patient use neonatal adapter had previously been used An airway zero should be performed only if the monitor displays ADAPTER CAL otherwise skip this step To perform an airway zero Rev 04 CO SMO User s Manual 23 Section A Single Patient Use Neonatal Airway Adapter 3a Press CAL PLACE ON ADPT IN RM AIR message appears 3b Place the sensor with airway adapter away from all sources of CO including the patient s and your own exhaled breath and ventilator exhaust valves 3c Press START TIME REMAINING counts down and the Main Menu reappears The actual airway zero will typically take less than 15 seconds If the monitor detects changing CO levels breaths during an airway zero BREATHS DETECTED is displayed followed by PLACE ADPT IN RM AIR To continue remove the source of the CO wait 30 seconds and press START 4 Install at the proximal end of the circuit between the ET tube and the ventilator wye The
60. N Li SELECT ETCO2 AVERAGING INST 1BR 10s 20s 4 v Yes SET AUDIO FEATURES C Select BREATHS DETECTED rh gt RUN PULSE ALERT PREV 6 5 13 26 MAIN Y peed TIME REMAINING XX SET ALERT VOLUME RUN H RUN f CANCEL T X PREV SET PULSE VOLUME v Show3sec Reset size of Pleth gt AA CAPNOGRAM CONTROLS RUN mm s SCALE 1 v SWEEP SPEED mm sec Breaths Detected Pog NO RESPIRATION TIMER XXs PREV AZero No CALIBRATION ERROR PREV H RUN TX CONT CO SMO Menu Tree Cul Chat JD 2 MAIN Revision 2 9 Software Page 1 of 4 Successful e SYSTEM OPTIONS SYSTEM OPTIONS K 3 4 RUN AUDIO LITE PRNT AVG v SELECT PRINT MODE RUN TREND TAB PREV MAIN MAIN v Start Tabular Printout v PRINT TREND Ch RUN ALL PART PREV MAIN is v
61. O values for the ETCO section and the saturation values and respiration rate for the SpO section are continually transmitted at one second intervals To enter Real Time mode the computer must send an ASCII 1 character The CO2SMO will echo back the 1 followed by a cr 1 and enable real time communication The data format is ME R I Y S p 7 cor lf where Event Marker identifier M event marked no event E an identifier for the a 3 digit ASCII CO value to follow R an identifier for the 3 digit ASCII Resp rate value to follow I an identifier for the 2 digit ASCII Inspired CO value to follow Y an identifier for a 2 digit ASCII CO status message value S an identifier for a 3 digit ASCII SpO value to follow P an identifier for a 3 digit ASCII Pulse value to follow Z an identifier for a 2 digit ASCII SpO status message value a 3 digit ASCII value a 2 digit ASCII value cr lf a carriage return line feed sequence If the units parameter is set to Kpa or in the CO2 SETUP OPTIONS menu then the E and I will include decimal characters and be in an E format for End Tidal value and for Inspired This is an additional ASCII character in the sequence Rev 04 CO SMO User s Manual 99 Section 14 NOVACOM Interface If the ETCO section is turned off while the SpO section remains on the E R an
62. O2 mode earlier version software does not support this option 36 co sMO User s Manual Rev 04 Section 6 SpO Sensors This section explains how to select an SpO sensor how to connect the sensor to the monitor and how to apply the sensor to that patient Connect only Novametrix saturation sensor extension cables and or SuperBright SpO sensors to COSMO Do not use other SpO sensors or accessories with CO SMO Before connecting to the patient or to CO SMO ensure sensor extension cables and or sensors are physically intact with no broken frayed or damaged components To attach a SuperBright sensor or sensor extension cable to CO SMO 1 Plug the connector into the rear panel SpO Input The connector clicks into place when properly seated Do not twist the connector Sensors may be connected or removed whether or not the monitor is turned on 2 To disconnect press the latch release lever pull the connector from the monitor Do not twist the connector PRESS DOWN ON LATCH RELEASE i a THEN PULL OUT al ti QUUM OxySnap Connectors To connect an OxySnap extension cable to an OxySnap SuperBright sensor 1 Align the arrows on the OxySnap connectors and press the connectors together 22222222 CET 2 To disconnect grasp the connectors at the finger grips and pull them apart CO SMO User s Manual 37 Section 6 Finger Sensor Finger Sensor The Finger Sensor is inten
63. OLUME appears An audible tone sounds and the current alert volume setting 1 7 is displayed between the up and down arrows 5 Press T or J to increase or decrease the alert volume setting 6 Press RUN to return to the Main Menu Audio Mute In situations where preventing the occurrence of audible alarms by use of the Audio Off feature is not desired the monitor can be set to disallow use of Audio Off Once the monitor is set to disallow use of Audio Off AUDIO OFF DISABLED is briefly displayed in the Message Center each time the user tries to enable Audio Off NOTE Unlike Audio Off the Two Minute Silence feature which temporarily silences the audible alarms for two minutes and then reactivates them is a separate feature and is not affected by the status of Audio Mute feature To enable or disable the monitor s ability to permanently silence the audible alarms 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS is displayed 2 Repeatedly press the NEXT key until ALERT OPTIONS 1 appears Rev 04 CO SMO User s Manual 63 Section 8 Limit Alerts Latched Unlatched 3 Press MUTE and ALLOW AUDIO OFF appears The current setting flashes 4 Press YES or NO as desired YES The user can use Audio Off to permanently silence audible alerts NO The user cannot use Audio Off AUDIO OFF DISABLED is displayed instead NOTE Once the decision to allow or disallow the user to use Audio Off is
64. ONS 2 reappears Press RUN to return to the Main Menu However if Unlatched Alerts are selected See Limit Alerts Latched Unlatched on page 64 the Alert Bar will turn off once the alerting parameter returns within its limits 66 co sMO User s Manual Rev 04 Rev 04 Section 9 Trend Memory Display Overview COSMO maintains trend information for ETCO Respiratory Rate SpO and Pulse Rate Trend memory is continually and automatically updated Trend memory can hold up to 24 hours of data The data is battery backed so turning the monitor off and on does not destroy or erase trend memory contents Trend memory features include e Graphical trend memory displays are user selectable Any 12 hour 8 hour 2 hour or 30 minute portion of trend data can be viewed on screen in graphical format s ETCO only ETCO and Respiratory Rate SpO only and SpO and Pulse Rate graphical displays are available e Graphical display scales are user selectable Histogram trend memory displays are user selectable Any 12 hour 8 hour 2 hour or 30 minute portion of trend data can be viewed on screen in histogram format e Userselected Events can be marked and stored in trend memory These events appear on screen when viewing the graphical trend displays e Trend memory data in graphical and histogram formats can be output to a printer e The user can erase stored trend memory at any time via the trend menus CO SMO continues patient
65. Pediatric sensor Rev 04 CO SMO User s Manual 49 Section 6 Single Patient Use SpO Sensors Ensure that the sensor heads are positioned directly opposite each other through the tissue The adhesive dots Catalog No 8700 which are included with each sensor can be applied to the sensor before patient application for additional adhesion to the site 6 For additional support secure the cable along the limb with tape WARNING Do not wrap the sensor around the limb so tightly that circulation is restricted Inspect the site often at least every four hours for adequate circulation When applying sensors take note of patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate Single Patient Use SpO Sensor Quick Check 1 With the sensor connected to monitor but not applied to the patient position the sensor heads so that they face each other the red light shines at the detector Is PROBE OFF PATIENT displayed 2 Secure the sensor on your index finger Does the monitor show reasonable SpO and pulse rate values 3 A YES to BOTH 1 and 2 indicates that the sensor is OK Apply the sensor to the patient as instructed above This quick check also tests the functionality of the extension cable 50 co sMO User s Manual Rev 04 Section 7 Monitoring SpO and Pulse Rate
66. RESIZING PLETH and allow five seconds for the display to reach an optimal display size then re lock the Signal Bar and plethysmogram displays vertical scale SpO Timers CO5SMO ensures that only valid pulsatile signals are processed Bad or invalid data causes alerts to occur These alerts are accomplished with the use of SpO Timers including the Display Held Timer the Special Alert Delay and the Bad Signal Timer Display Held Timer The Display Held Timer activates if the monitor cannot detect a regular and rhythmic pulsatile signal for periods longer than 10 seconds While the Display Held Timer is active NO SAT UPDATE is displayed in the Message Center and SpO and Pulse Rate displays are not updated the last valid values are Held The timer display indicates how old the displayed SpO and Pulse Rate information is The Display Held Timer can be activated by excessive motion e improper sensor placement INSUFFICIENT LIGHT or PROBE OFF PATIENT messages e electrosurgical interference CO SMO User s Manual 53 Section 7 SpO Timers e ambient Light Interference e Low pulsatile Signal Strength The SpO and Pulse Rate displays blank out and display if the duration of the invalid data exceeds the Special Alert Delay setting Once started the Display Held Timer remains active for as long as invalid data is received from the sensor After 99 seconds the timer display remains at 99 The Display H
67. S 2 appears 3 Press the SER serial interface key and the currently selected interface appears Available interfaces include INTERFACE UNUSED PRINTER INTERFACE NOVACOMI INTERFACE ANALOG MODULE INTERFACE MEMORY CARD INTERFACE TELECAP INTERFACE and TELESAT INTERFACE 4 Press PREV previous or NEXT to select TELESAT INTERFACE The TeleSat interface is now selected for the CO SMO 5 Press RUN to return to the Main Menu Rear Panel RS232C Pinout The CO5SMO rear panel RS232C connector s pinout is illustrated below 5 RS232 High reference CTS Clear to Send 6 3 Transmit Ground reference 7 2 Receive 5 volts DC 25 14 Unregulated RS232 Low reference 20 DC Supply 19 TTL level transmit 108 co swo User s Manual Rev 04 Section 15 Maintenance This section contains CO SMO monitor and accessory maintenance information Cleaning and Sterilization Follow the cleaning and sterilization instructions listed below to clean and or sterilize the monitor and its accessories Monitor e Turn the monitor off and unplug the line cord from the AC power source before cleaning e The monitor can be cleaned and disinfected with solutions such as a 70 isopropyl alcohol 2 gluteraldehyde or 1046 bleach solution Then wipe down with a water dampened clean cloth to rinse Dry before use e Do not immerse the monitor e Do not attempt to sterilize the monitor SpO Finger Sensor e The sensor can be cleaned and disinfected
68. START XX XX dd mm yyyy RESET Y Y v LA STOP XX XX dd mm yyyy RESET ue Vv Prints Selection o SELECT PRINT COMPRESSION NONE 1 2 1 4 PAGE PREV y vy 4 Print Selection ALRT TREND SIZE CAL MENU RUN AUDIO LITE CARD AVG l v Ch ETCO2 12 Hr RUN EXPAND lt gt NEXT NOVACARD MENU x Y ER H RUN STORE ID ERASE TIME C MAIN Cursor 2 gt ETCO2 8 Hr RUN EXPAND lt gt NEXT i p Ga Ge ege v was pressed y ETCO2 2 Hr RUN EXPAND lt gt NEXT n PATIENT ID ___ i i SET CLR SELECT T y C MAIN J C Cursor D i v ETCO2 30m RUN EXPAND lt Se NEXT C Clears Patient ID field gt C Edit Patient ID field gt Y yy C MAIN C Cursor gt m TREND OPTIONS RUN ERASE VIEW PREV MAIN gt CARD will appear if NOVACARD Interface TREND VIEW SCAL DUAL co2 HIST PREV is selected PRNT will appear if PRINTER Interface is i selected Otherwise key is blank C In ETCO2 view toggles vertical scales gt v RASE Selects ETCO2 amp Resp or SpO2 amp Pulse C Select ET CO2 or SpO2 E TREND OPTIONS pne B VIEW IND PES ERASE STORED TRENDS YES NO MAIN LA m gt NOVACARD MENU RUN STORE ID ERASE PREV MAIN es ai TREND OPTIONS RUN ERASE VIEW PRNT PREV Vv ERASING CARD PLEASE WAIT No Yes L p B SET CLR SELECT T v Select 0 9 for each point PRINTOUT
69. T ON BAD SIGNAL SET PREV NEXT 0s 15s 30s 60s ke j A A J J TELESAT INTERFACE Select Delay Delay SET PREV NEXT 1 INTERFACE UNUSED SET PREV NEXT ym t 4 PRINTER INTERFACE SET PREV NEXT en ALERT OPTIONS 2 x ALERT OPTIONS 1 4 e RUN DELAY BAR NEXT RUN LATCH DFLT MUTE NEXT SELECT PRINTER TYPE SEIKO TJET MAIN MAIN J v Select Type 10 SEC LIMIT ALERT DELAY ALERTS LATCHED 4 YES NO YES NO XX XX DD MMM YYYY SET SEL bf KE DENEN ALERT BAR LATCHED RETAIN ALERT LIMITS PE MES T NOS UOTE YES NO CALIBRATE RECORDER RUN ZERO HALF FULL PREV f C Yes No Off Yes No i d MAIN YC Set scale 3 a ALLOW AUDIO OFF YES NO K 4 N CO SMO Menu Tree es NO ON Revision 2 9 Software Page 4 of 4 Rev 04 Section 12 Status Messages Certain status messages may appear on the display of the CO SMO ETCO SpO monitor Model 7100 These messages are listed in the following table with an explanation of the probable causes Message Displayed Possible Explanation ETCO2 SECTION CO2 SENSOR FAULTY 1 Try different sensor If problem persists a hardware error with the monitor most likely exists or sensor is defective CO2 SENSOR FAULTY 2 The values stored inside the sensors EEPROM failed the checksum test Check that the sensor is properly plugged in If problem persists return the sensor to the factory for servicing CANNOT CALIBRATE THIS SENSOR Occurrenc
70. TAT CO Sensor is placed onto an Airway Adapter and the airway adapter is placed in the patient s airway circuit typically between the ventilator elbow and the patient wye See CAPNOSTAT CO Sensor on page 17 Infrared light is generated in one leg of the U shaped sensor and then beamed through the windows of the airway adapter to a detector in the other leg of the sensor Carbon dioxide flowing in the airway adapter as a result of respiration absorbs some of this light energy The monitor relates the amount of detected energy to the amount of CO in the sample cell the airway adapter This results in a capnogram display and numerical values for CO and respiration rate CO SMO uses an adaptive digital detection algorithm system incorporating highly accurate digital filters and adaptive thresholds to cover a wide range of monitoring situations including rebreathing neonatal respiratory rates and CO levels and adult OR and ICU conditions without the operator having to change monitor settings Respiration is calculated by measuring the time interval between detected peaks of the CO waveform The inverse of this measurement is displayed as respiratory rate Certain rebreathing circuits or the presence of artifact such as cardiogenic oscillations may cause CO7SMO to react to non respiratory CO fluctuations as if they were breaths this condition affects only the numerical displays the Capnogram display continues to provide an accurate
71. Waveform mode the end tidal value respiratory rate inspired CO and CO error messages are continually transmitted at one second intervals CO waveform data is also continually transmitted 48 times per second 100 co swo User s Manual Rev 04 NOVACOM1 Interface External Devices Rev 04 To enter CO Waveform mode the computer must send an ASCII 3 character The CO SMO will echo the 3 followed by a cr 1f and then enable communication The data format is ME R I Y cr Llf sent once a second ctt lt cr gt lt lf gt sent 48 times a second where Event Marker identifier M event marked no event E an identifier for a 3 digit ASCII CO value to follow R an identifier for a 3 digit ASCII Resp rate value to follow I an identifier for the 2 digit ASCII Insp CO value to follow Y an identifier for a 2 digit ASCII CO status error value a 3 digit ASCII value a 2 digit ASCII value c an identifier for a 2 digit waveform data point to follow a 2 digit ASCII value in the range 0 99 lt cr gt lt 1f gt is a carriage return line feed sequence The Y CO Error message value represents the current status of the parameter A value of 00 is returned if no error is active Refer to Mode 1 Real Time on page 99 for a complete list of error messages 66 To exit CO Waveform mode the computer must send an ASCII x
72. a Respiratory Interval Alert the user presses Ier e The audible alert and Red Alert Bar are reset e The J indicator continues to flash and the NO RESP timer remains displayed The Respiratory Interval Alert will not activate until the monitor detects some initial respiration and displays a nonzero Respiratory Rate This keeps the alert from activating before the sensor is connected to the patient s airway Selecting the Respiratory Interval Alert Timer Duration To select the Respiratory Interval Alert Timer duration 1 From the Main Menu press MENU 2 When the CO2 OPTIONS screen appears press NEXT The SYSTEM OPTIONS menu will appear 3 From the SYSTEM OPTIONS menu press AVG 4 From the AVERAGING SELECTIONS screen select No Resp 5 The NO RESPIRATION TIMER screen will appear From the NO RESPIRATION TIMER screen select the time by using the arrow keys The time is selectable from 10 seconds to 60 seconds in 5 second increments Press PREV to return to the previous menu AVERAGING SELECTIONS Pressing the PREV softkey will return to the previous screen without saving any changes in the no respiration timer 6 When the desired time is displayed press the RUN softkey to return to the Main Menu The displayed time will be saved and the monitor will return to the Main Menu Respiratory Rate Editor Certain rebreathing circuits or the presence of artifact such as cardiogenic oscillations may cause CO5SMO s adaptive di
73. adapter into the CAPNOSTAT CO Sensor Align the arrow on the bottom of the airway adapter with the arrow on the bottom of the CAPNOSTAT CO Sensor Press the sensor and airway adapter together until they click 3 Ifnecessary perform an adapter calibration Otherwise skip this step Adapter Calibration needs to be performed each time you switch airway adapter types for example if you switch from using an Adult to a Neonatal adapter but not if you switch from Rev 04 CO SMO User s Manual 21 Section A Neonatal Airway Adapter one Neonatal adapter to another Neonatal adapter Adapter Calibration should also be performed if the monitor displays ADAPTER CAL To perform an Adapter Calibration Press CAL PLACE ON ADPT IN RM AIR message appears Place the sensor and airway adapter away from all sources of CO including the patient s and your own exhaled breath and ventilator exhaust valves Press START TIME REMAINING counts down and the Main Menu reappears The actual calibration will take typically less than 15 seconds NOTE If the monitor detects changing CO levels breaths during an adapter calibration BREATHS DETECTED is displayed followed by PLACE ON ADPT IN RM AIR To continue remove the source of COs wait 30 seconds and press START 4 When using the Neonatal Airway Adapter place the CAPNOSTAT CO Sensor Airway Adapter assembly between the endotracheal tube and the ventilator circuit
74. alerting parameter returns within its limits before 10 seconds elapse the Alert Bar turns off If the alert condition lasts for more than 10 seconds the flashing Alert Bar becomes latched and will continue to flash even if the alerting parameter returns within its limits until the user presses the key An Unlatched Alert Bar starts flashing 10 seconds after an alert limit violation occurs and turns off as soon as the alerting parameter returns within its limits regardless of the duration of the alert The Alert Bar will not flash under any condition if it has been turned Off NOTE The red Y bell shaped indicator to the left of the al key will always flash whenever a limit alert occurs Unlike the Alert Bar A cannot be turned off To turn the Alert Bar on latched or unlatched or off 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS is displayed 2 Repeatedly press the NEXT key until ALERT OPTIONS 2 appears 3 Press BAR and ALERT BAR LATCHED appears The current setting flashes 4 Press YES or NO or OFF as desired YES Alert Bar starts to flash as soon as a limit alert occurs NO Alert Bar starts flashing 10 seconds after an alert limit violation occurs OFF Alert Bar will not flash under any condition NOTE Once the Alert Bar setting is selected that choice remains in effect even if the monitor is turned off and on until changed by the user 5 ALERT OPTI
75. and Connectors SpO Input Connector The SpO Sensor plugs into this connector Connect only Novametrix SuperBright SpO sensors to the CO SMO SpOz Input Connector Do not use other SpO sensors with CO SMO An INCOMP SpO2 PROBE message indicates a non compatible sensor is connected AC Mains Power Module The AC Mains line cord plugs into the Power Input Module and is held in place with the line cord retaining clip The monitor s voltage setting i e 115 VAC is displayed on the module When the power switch is set to the I position AC Mains line voltage will power the monitor and recharge the battery if the line cord is connected If the power switch is set to the O position AC Mains line voltage is prevented from reaching the monitor s power supply and the monitor must operate from its internal battery Sampling System Exhaust Connector This port is provided so that gas analyzed with the Sampling Airway Adapter and tubing can be scavenged as needed Data Communications Port The RS232C Novametrix Accessories connector provides an interface to external equipment such as a printer and other external optional accessoriesw 10 co swo User s Manual Rev 04 Rev 04 Section 2 Patient Safety The COSMO SpO Input is electrically isolated Patient leakage current flowing from the instrument to ground is limited to less than 10 WA at 120 VAC 60 Hz Patient isolation is greater than 10 MQ 2500 VAC rms at 60
76. aphical trend type and expansion setting For example if the graphic trend display is set to an ETCO 12 hour display the resulting histogram reflects that 12 hours of ETCO and Respiratory Rate information If the graphic display is set to an SpOs 30 minute display the resulting histogram reflects that 30 minutes of SpO and Pulse Rate information Histogram displays reflect only active monitoring time the time the Capnostat spends on the Zero and Reference Cells is NOT reflected in the histogram display likewise SpO sensor non monitoring time such as SpO2 PROBE OFF PT is NOT reflected in the histogram display To activate a histogram trend display 1 Press the TRND softkey Wait for the trend to be displayed Move the cursor by pressing the or gt arrow keys to the desired time Press the EXPAND softkey to select the desired trend duration Press the NEXT key TREND OPTIONS appears Press the VIEW key TREND VIEW appears oe ot on Press the HIST histogram key to display the histogram The top line of the histogram display shows the start and stop dates and times in 24 hour format used to tabulate the data ETCO data or SpO data is tabulated on the left side of the display and Respiratory Rate data or Pulse Rate data is displayed on the right half Data for each parameter is tabulated into six categories Each category represents a range of possible values For each category a bar graph is drawn showing the percen
77. as NO RESP When an alert occurs the alert indicator flashes and the violated limit displays and the red alert bar may flash and an alarm may sound Once the alert condition is fixed J and other flashing displays may continue even though the audible alarms stop Press the key to stop an alert condition that is not currently active Any alert messages flashing indicators or audible alerts will be disabled Currently active alerts will be reset and again become active once any time out period has elapsed In certain conditions such as NO RESP pressing i will reset silence the audible alerts until monitoring is resumed and the monitor again displays end tidal and respiration rate values If AUDIO OFF DISABLED appears when the user activates AUDIO OFF refer to Audio Mute on page 63 CO SMO User s Manual T Section 1 8 COSMO User s Manual Front Panel Controls and Connectors The Menu SOFTKEYS The Menu Center display area is located just above the five unmarked softkeys Softkeys perform the action displayed above each key For example above the rightmost softkey in the Main or Base Menu is a MENU key Press MENU and new menu and softkey functions are displayed Press RUN to return to the Main Menu RUN always displays the Main Menu NEXT and PREV previous move through the menus one level at a time The Main Menu will reappear if no key is pressed for one minute The time out is extended to five minutes if t
78. ation of version 1 9 software To compensate for barometric pressure 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Press the BARO barometric pressure key BAROMETRIC PRESSURE appears The current barometric pressure setting 560 780 mmHg is displayed and the current selection MANUAL or AUTO will flash 3 Press AUTO or MANUAL as desired Press AUTO to select monitor s automatic barometric pressure compensation The monitor will briefly display AUTOMATIC BARO PRESSURE COMPENSATION SELECTED Press MANUAL to manually enter barometric pressure compensation Press T or 1 to increase or decrease the barometric pressure setting Rounding to the closest setting results in less than a 0 1596 error in the CO value 4 Press RUN to return to the Main Menu To compensate for barometric pressure with revision 1 9 software 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Press the BARO barometric pressure key BAROMETRIC PRESSURE XXX mmHg appears XXX will be the current barometric pressure setting 560 780 mmHg 3 Press T or as desired Press T or to increase or decrease the barometric pressure setting Rounding to the closet setting results in les than a 0 15 error in the CO value Pressing the PREV key will display the CO2 SETUP OPTIONS menu 4 Press RUN to return to the Main Menu ETCO Calculation COSMO is configured when shipped from the
79. atric 10 per box Nasal CO Sampling and O Delivery Cannula Adult 10 per box Nasal CO Sampling and O Delivery Cannula Pediatric 10 box Nafion Dehumidification Tubing 10 per box Sidestream Monitoring Kit for Pediatric Tracheostomy Patients 10 per box SINGLE PATIENT USE SpO SENSORS AND CABLES Pediatric Adult Single Patient Use SpO Sensor Terminates in DB9 connector 10 per box Pediatric Adult Single Patient Use SpO Sensor Terminates in DB9 connector 25 per box Neonatal Pediatric Single Patient Use SpO Sensor Terminates in DB9 connector 10 per box Neonatal Pediatric Single Patient Use SpO Sensor Terminates in DB9 connector 25 per box DB9 Extension Cable For use with Single Patient Use sensor above DB9 OxySnap Connector cable Use to connect Single Patient Use sensors to OxySnap connector OxySnap SpO SENSORS OxySnap Y Sensor use with OxySnap Extension Cable OxySnap Finger Sensor use with OxySnap Extension Cable OxySnap Extension Cable 8 ft use with OxySnap sensors OxySnap Long Extension Cable 12 ft use with OxySnap sensors OxySnap SENSOR ACQUISITION PLANS Select an OxySnap Finger Sensor or Y Sensor Plan for each SuperBright Pulse Oximeter The plan you select determines the warranty period 12 24 or 36 months How the Plans Work Included in each Plan are TWO sensors one for immediate use the
80. bly at the proximal end of the airway circuit between the elbow and the ventilator circuit wye Shown with CAPNOSTAT CO Sensor Cat No 7167 may also use Cat No 7067 Cable Clip Cat No 8751 Adult Airway Adapter Cat No 7007 D D e For optimal results do NOT place the airway adapter between the ET tube and the elbow as this may allow patient secretions to block the adapter windows e Position the Airway Adapter with its windows in a vertical and NOT a horizontal position This helps keep patient secretions from pooling on the windows If pooling does occur the airway adapter may be removed from the circuit rinsed with water and reinserted into the circuit e To prevent rain out and moisture from draining into the Airway Adapter do NOT place the Airway Adapter in a gravity dependent position Single Patient Use Airway Adapter with Mouthpiece The single patient use airway adapter with mouthpiece Catalog No 6421 can be used for spot checking CO on non intubated adult or pediatric patients CAUTION The airway adapter with mouthpiece is intended for single patient use Do not re use or sterilize the adapter as system performance will be compromised Instructions for use 1 Verify that the adapter and mouthpiece are intact and securely fastened to each other 20 co sMO User s Manual Rev 04 Neonatal Airway Adapter CAPNOSTAT CO Sensor 2 Press the C
81. byte 0 IT TkkkkkkkkkEkkk KK KK KKKKKKK KK k k kk KKK KKKKKKKKKKKKK KKK KKKKKKK ck ck k k kk KKK Ckckckckckckckckckckckck kck pc Scere ts byte 39 T Trend mode identifier DATA byte starting at byte 0 and ending at byte 39 see below byte 0 7 8 byte ETCO2 data range units mmHg 0 100 units Kpa 0 133 units 0 133 251 no data available over period pen lift byte 8 15 8 byte respiration rate data range 0 150 251 no data available over period byte 16 23 8 byte inspired data range 0 30 31 no data available over period EVENT marker on if MSB is set AUDIO off is 2nd MSB is set byte 24 31 8 byte SpO2 data range 1 100 0 no data available byte 32 39 8 byte pulse rate data range 0 250 251 no data available over period cr carriage return If line feed Mode d Date and Time Date and Time mode causes the CO SMO to transmit on request the date and time as calculated by the monitor s internal calendar clock To request the date and time the computer must send an ASCII d character The monitor echoes back the d character and sends the date and time on the same line The Mode d data format is d MMM DD YY hh mm ss cr lf where d the echoed command character e is an ASCII space character MMM a 3 character month Jan Dec DD a 2 digit ASCII day 01 31 YY the last 2 digits of the year 1990 is 90
82. cable of the CAPNOSTAT CO Sensor should be facing away from the patient CAPNOSTAT CO Sensor Neonatal airway adapter Position the airway adapter with its windows in a vertical and NOT a horizontal position This helps keep patient secretions from collecting on the windows If pooling does occur the airway adapter may be removed from the circuit rinsed with water and reinserted into the circuit e For routine performance of airway care separate the system between the ET tube and the airway adapter Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the neonatal airway adapter windows 5 Ensure the integrity of the patient breathing circuit after insertion of the airway adapter by verifying a proper CO waveform capnogram on the monitor display 24 co sMO User s Manual Rev 04 Sampling Airway Adapter CAPNOSTAT CO Sensor Sampling Airway Adapter The Sampling Airway Adapter with tubing Catalog No 5843 should be used in conjunction with a nasal sampling cannula to monitor non intubated patients and to provide sidestream monitoring of pediatric tracheostomy patients Non Intubated Patients 1 Verify the windows are clean and dry Clean or replace the adapter if necessary 2 Snap the airway adapter into the CAPNOSTAT CO Sensor Align the arrow on the bottom of the airway adapter with the arrow on the bottom of the CAPNOSTAT CO Sensor Press the sensor and airway adap
83. clean e Never sterilize or immerse the monitor in liquids e Connect the line cord only to a grounded hospital grade outlet CO SMO should be connected to the same electrical circuit as other equipment in use on the patient Outlets on the same circuit can be identified by the hospital s engineering department e Patient Safety Care should be exercised to assure continued peripheral perfusion distal to the SpO sensor site after application COSMO User s Manual 11 Section 2 Cautions e The COSMO is not intended to be used as a primary diagnostic apnea monitor and or recording device e Inspect the SpO sensor site often for adequate circulation at least once every four hours When applying sensors take note of the patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate e Data Validity As with all pulse oximeters inaccurate SpO and Pulse Rate values can be caused by any of the following ncorrect application or use of a sensor Significant levels of dysfunctional hemoglobin carboxyhemoglobin or methemoglobin Significant levels of indocyanine green methylene blue or other intravascular dyes Exposure to excessive illumination such as surgical lamps especially ones with a xenon light source or direct sunlight Excessive patient movement venous pulsations electrosurgical in
84. d fields will be followed by blanks Likewise the S and P fields will be followed by blanks if the SpO section is turned off while the ETCO section remains on The Y CO and Z SpO values correspond to CO SMO display messages e g Check Airway Adapter The messages corresponding to the displayed numbers are shown below Yu ES ds ek Capnometer messages where is SpO messages 00 No Error 00 No Error 01 N A 01 N A 02 Connect CO Sensor 02 SpO Low Signal 03 CO Sensor Overtemp 03 SpO Insuf Light 04 CO Sensor Faulty 04 Pulse Out of Range 05 Incomp CO Sensor 05 N A 06 Calibrator Faulty 06 SpO Light Interf 07 CO Sensor Warm up 07 SpO Reflex Probe Off 08 same as above 08 SpO Probe Off Patient 09 Place on Zero Cell 09 Connect SpO Probe 10 same as above 10 Incomp SpO Probe 11 CO Zero Cal Error 11 Can t ID SpO Probe 12 N A 12 SpO Faulty Probe Ir 13 CO Adapter Cal Error 13 SpO Faulty Probe Rd 14 Cal on Airway Adapt 14 SpO Faulty Probe 15 Check Airway Adapt 15 N A 16 same as above 16 SpO Hardware Err 17 ETCO Out of Range 17 SpO Bad Signal 18 N A 19 Baro Press Error 20 Check Sampling Line 21 Sample Line Blocked To exit Real Time mode the computer must send an x and then stop real time communication Mode 3 CO Waveform 66 X Or X character The COSMO will echo the In CO
85. d foreign patents pending Rev 04 COSMO User s Manual 1 Acknowledgments This page intentionally blank 2 CO SMO User s Manual Rev 04 Rev 04 Section 1 Introduction The Novametrix CO SMO ETCO SpO Monitor Model 7100 is a lightweight easy to use combination capnograph and pulse oximeter monitor designed for use in a variety of clinical settings It provides reliable measurement display and alerts for end tidal carbon dioxide ETCO respiration rate functional pulsatile oxygen saturation SpO gt and pulse rate The included sampling system allows CO monitoring of non intubated patients Numerical and waveform information is presented on a bright Cold Cathode Display CCD with user adjustable contrast to optimize viewing angles A simple menu system allows user selection of measurement and display options Alerts are menu programmable or automatic Presence of a pulse is indicated audibly by a user selectable beep Separate 24 hour trends for ETCO respiration rate SpO and pulse rate are updated every 8 seconds Trend events and audible alarm status Audio Off are also stored in trend memory COSMO has a serial port RS232 for interfacing to external equipment The monitor can be powered from the AC Mains or from its rechargeable two hour battery CO Principles of Operation COSMO measures carbon dioxide and respiratory rate with a unique solid state device called a CAPNOSTAT CO Sensor The CAPNOS
86. d their accessories Monitoring SpO and Pulse Rate on page 51 describes those monitor features directly related to monitoring SpO and Pulse Rate Alerts on page 59 provides information on the various monitor alerts Trend Memory Display on page 67 details CO SMO s trend memory features Miscellaneous Features on page 73 describes features not directly linked to specific sections of this manual Menu Tree on page 75 diagrams the menu flow of the COSMO Status Messages on page 81 lists the various messages that may appear on the CO SMO display and lists possible causes Using a Printer on page 85 describes the various printers CO2SMO supports and the formats of the various printing modes External Devices on page 99 describes the various externally conected options available that operate with the CO SMO Maintenance on page 109 lists monitor sensor and accessory cleaning and sterilization instructions Specifications on page 115 detail the CO SSMO ETCO SpO Monitor Model 7100 Accessories on page 117 lists CO SMO ETCO SpO Monitor Model 7100 accesories Typical Capnogram Waveforms on page 123 provides additional capnogram related information Acknowledgments CAPNOSTAT is a registered trademark and COSMO SuperBright Y Sensor and Y Strip are trademarks of Novametrix Medical Systems Inc Other trademarks and registered trademarks are owned by their respective companies U S A an
87. ded for adult fingers and not designed for neonatal or pediatric applications EE E Z2o242222 eau UENIT em To apply the finger sensor to the patient 1 Gently squeeze the grips at the rear of the sensor indicated by arrows below Placement Guide Cable exits above finger 2 Position fingertip against placement guide with fingernail towards the red light Do not position the finger so as to protrude past the placement guide 3 Release the finger grips 4 Inspect the site often for adequate circulation at least once every four hours 5 To remove sensor gently squeeze grips and slide the sensor from the finger Finger Sensor Quick Check 1l Is SpO2 PROBE OFF PT patient displayed when the sensor is connected to the monitor but not applied to the patient n Apply the sensor to your index finger Are reasonable SpO and pulse rate values displayed 3 AYES to BOTH 1 and 2 indicates the sensor is OK Apply the sensor to the patient as instructed above 38 co SMO User s Manual Rev 04 Y Sensor SpO2 Sensors Y Sensor The reusable Y Sensor is a flexible sensor designed for use on any patient The Y Sensor s Center Strip is not a functional part of the sensor Its twofold purpose is to aid in the placement of the sensor into the Y Strip or other securing system and to limit the distance between the sensor heads to no more than 25 mm The center strip may be removed carefully cut away if the distanc
88. dump the computer must send an ASCII 6 character The monitor echoes back the 6 character and transmits the first INFO record 102 co swo User s Manual Rev 04 NOVACOM1 Interface The Mode 6 data format is INFO record ES byte 0 TARAKKKKKKKKKKKKKKK KK KK KK k k ck ck ck k KKK KKK k kk KKK External Devices ORCA TL A NONNUNUAGACRSAUNORDAUNUR E I AUK AU o te Cis SE where byte 39 T Trend mode identifier INFO byte starting at byte O and ending at byte 39 see below byte 0 flag byte FF for INFO record byte 1 information type FE power on FD limit change FC time stamp byte 2 model code 1 byte 3 CO2 units 02mmHg 1 Kpa 2 byte 4 seconds 00 36 0 59 decimal byte 5 minute 00 36 0 59 decimal byte 6 hour 00 17 0 23 decimal byte 7 day 01 1F 1 31 decimal byte 8 month 01 0C 1 12 decimal byte 9 year 00 63 0 99 decimal byte 10 End Tidal limit high byte 11 End Tidal limit low byte 12 Resp Rate limit high byte 13 Resp Rate limit low byte 14 SpO2 limit high byte 15 SpO2 limit low byte 16 Heart Rate limit high byte 17 Heart Rate limit low byte 18 through byte 39 unused cr carriage return If line feed Rev 04 COSMO User s Manual 103 Section 14 NOVACOM1 Interface 104 DATA record
89. e between the sensor heads needs to be reduced to less than 25 mm Sensor Heads Strip may be removed Y Sensor Application using Wrap Style Tapes 1 Select a Y Strip based on the patient type and intended sensor location Y Strips come in two color coded sizes 25 mm tapes have green liners and 20 mm tapes have blue liners The size refers to the distance between the holes in the tape Wrap Style Tape Finger Style Tape Cat No 8829 Cat No 8828 Cat No 8832 Cat No 8831 25 mm Green 20 mm Blue 25 mm Green 20 mm Blue Neonatal Foot Hand Neonatal Foot Hand Adult Finger Pediatric Finger Pediatric Toe Finger Adult Finger 2 Remove the portion of the release liner containing the holes I m 3 Skip this step if using the 25 mm Y Strip tape If using the 20 mm Y Strip tape carefully remove the sensor s center strip using a pair of scissors or a sharp blade The center strip does not effect sensor operation its purpose is to aid putting the sensor into the 25 mm tape and to limit the distance between the sensor heads to no greater than 25 mm Rev 04 CO SMO User s Manual 39 Section 6 Y Sensor 4 Press the button on the back of each sensor head through a hole in the tape Press in from the sticky side of the tape The tape will stretch to fit the sensor button Liner this side top A v 7 Head Y Strip Tape Button Cross Section 5 Remove the remain
90. e for data archiving optional 116 cosmo User s Manual Rev 04 Rev 04 Section 17 Accessories COSMO Capnograph and Pulse Oximeter Catalog No 5758 00 7167 00 7007 00 7053 00 5843 01 5843 30 5843 50 5843 00 6063 00 6063 25 6421 00 Description CO SMO is a combined Capnograph and Pulse Oximeter Monitor It provides reliable mainstream measurement and display of end tidal carbon dioxide ETCO and respiratory rate The CAPNOSTAT CO Sensor features rugged solid state construction and is small and lightweight Reusable sterilizable low dead space airway adapters are available for monitoring adults neonates and non intubated patients CO SMO s pulse oximeter provides reliable measurement and display of the percentage of oxygen saturation of arterial blood SpO5 and pulse rate Reusable finger and Y Sensors are available for adult pediatric and neonatal monitoring applications The monitor provides a selectable capnographic or plethysmographic waveform on screen trending and histogram display of ETCO respiratory rate SpO and pulse rate for up to 24 hours A calendar clock allows events and the time they occur to be marked in trend memory RS232 computer and printer interfaces are standard CO SMO uses a large SuperBright Cold Cathode Display CCD has a built in combination kickstand and bedrail hanger and can operate from AC power or its internal two hour battery A sampling system for non intubated patients
91. e of any of the following conditions sensor is unplugged over temperature faulty incompatible or calibrator is faulty CO2 SENSOR WARM UP The CO sensor has not reached proper operating temperature A cold sensor may take several minutes to warm up less time is necessary for a sensor at room temperature Maximum warm up time should be five minutes Wait for sensor to stabilize If error persists try a different sensor Other monitor functions are not affected WAIT FOR SENSOR The sensor is unplugged under temperature over temperature or temperature is stabilizing Other monitor functions are not affected CHECK AIRWAY ADAPTER ADAPTER CAL Usually caused by blockage of the optical path of the sensor or when the airway adapter is removed May also be caused by failure to perform adapter calibration to correct for adapter type Clean airway adapter if necessary check calibration Perform adapter calibration if problem persists perform zero calibration Perform another adapter calibration if using another adapter CONNECT CO2 SENSOR CO sensor not plugged into the monitor This message will be displayed until a sensor is plugged into the CO input connector CO2 SENSOR OVER TEMP Sensor temperature is greater than 50 degrees Celsius Check that the sensor is not exposed to excess heat If message persists a hardware problem is likely INCOMPAT CO2 SENSOR The EEPROM inside the sensor co
92. ee ere ei te eei RE I ERR ERE Rh 110 Reusable Adult Airway Adapter sessi eene nene ene 110 Reusable Neonatal Airway Adapter sess 110 External Sampling System Components eese nennen 111 Single Patient Use Airway Adapters sees 111 Internal Sampling System Components sess 111 Maintenance Schedules i nte etitm t Rte eee cas tern ge Reto 112 Battery Maintenance ainei iore e EEEE E EE EEN REESE EVE ee ahaa DES 112 Mains Voltage Configuration sess etre nenne tree enr en nennen nene 113 Fuse Replacement 5 etienne utter ate Ee UR dee be 113 e m 115 General ole BEES BUER 115 Capnograpb E 115 Oximletef is eee lo tec b dte ets ec d te Ue red 116 Monitor Specificati ns eie ep herpes rU caste EEE EEEE E TETEE pee EE 116 X COSMO User s Manual Rev 04 Rev 04 Additional Features un INSGzie e ied Tee ae ie M UU 116 y nn 117 CO2SMO Capnograph and Pulse Oximeter essere 117 Typical Capnogram Waveforms eeseeeseseeeeeeeees seen nennen annie nnn nn nass na REENEN 123 Normal Waveform Aker EEN PRODI Mp 123 Cardiogenic Oscillations eee phe ee aetieiten genit etes e Ner repete 123 Hypoventilation erre there ttt rrr et E Ene er E DEAE IR EP eene EEA 124 HyperventilatiOn serrurier e ee RUIT Irt ER ertt Ln ttes R vt bee bee eb 124
93. eeeee eese nennen nennen nnnm nnnm tnra nante uana 73 Keychck Volume 45 5 r pire Ss Sie ce dt EEN 73 Display Brightness EE 73 Display Colors e ho etr teer re EORR PE TRECE E PE Ee rhe rapa 73 Setting the Clock Calendar erede ger e ice tiene ei SEU 74 Display Monitor Software Revision Level ees sesenta 74 j 75 Status E E 81 USING KH Gell EE 85 Selecting Specific Printer ses 85 Connecting the Seiko DPU 414 Thermal Printer 0 0 cece cee cess ceeeeeeeeeeeeee 85 Configuring the Seiko DPU 414 Printer eese 86 Connecting the Seiko DPU 411 Printer essen eene 87 Connecting the Hewlett Packard ThinkJet Printer eee 89 Print E 89 Displayed Trend Printo t torsen eene ie enne 89 Tabular Mode Text Printout 0 csscscsccsssstscsssssssnesetessesesicesasssvesnebeasisbatesessecesoeysbaeees 90 Rev 04 CO SMO User s Manual ix Capnogram or Plethysmogram Waveform Printout 000 cece eeeseeceeeeceeeeseeeeeeeee 90 Zoom Trend Printout oec ertet UN Seo e iei s 90 Compressed Trend Printout essssssssesseeeeee ener nennen nennen 91 Interpreting Printer Output sre oe couse eec ep e ER edu d ER ee pen 92 Header ESEE EEE AEE ENES ENE ee ae hee de dedit 92 Graphical Data e geesde e esteso cbe ce ees 94 Histogram D t vue ii GU BAS ie ae EE 94 Tabular Data FOtmat ertt pe bee etes ei eaten 94 Capnogram or Plethysmog
94. eeeee eren ener enne 9 Rear Panel Controls and Connectors esee eene nennen entrent 10 SpOs Input Connector tete ettet n e e eR e ei cipit 10 AC Mains Power Module 10 Sampling System Exhaust Connector eese ener 10 Data Communications Port sessi eene en nre nennen nee 10 Patient Safety eege es eiie udine edel edd 11 Indications and Usage sinirine ee as pei DH pei EE eie e ends 11 Eu MC HM 11 CautloDS iota ree RE OR e E RUD UR PU m eec duree 12 Monitor Power Up uenerunt eene exec e ce EENS 15 Monitor PowerUp patere gere et e RE HERR GR P REOR EE EO Pe eges er iE epis 15 Monitor Power Down etenim e eH e P Ee re IUE d rere ies 16 AC Mains Operation 2 aie Rp RO Uie Ee pee ge ER ee E EEUU RR gae LER 16 Battery Operation riirii er esra ert eto pete dele S baie ise 16 CAPNOSTAT CO Sensor sees ener enhn trn an trien n inne sine sane e inner seran 17 Airway Adapter Selection oe e marier e tiit eden decine nte 17 Adult Airway Adapter eis E 17 Single Patient Use Adult Airway Adapter esses eene ener nennen 19 Single Patient Use Airway Adapter with Mouthpiece essere 20 Neonatal Airway Adapter eee eter eter ehe nhe ESEEEEEEE nte eer ee bk NEE e 21 Single Patient Use Neonatal Airway Adapter sse ener 23 COSMO User s Manual Vii Sampling Airway Adap
95. eld Timer is reset to zero seconds and the timer message disappears as soon as a regular and rhythmic pulsatile signal is detected The timer display message can be disabled by the user if desired In this case the timer display will not appear but the SpO and Pulse Rate displays will still blank out if the Special Alert Delay is exceeded The Display Held Timer is set by the factory defaults to Off The Display Held Timer affects all Timer Displays See Special Alert Delay on page 54 and Bad Signal Timer on page 55 To determine or alter the current setting of the Display Held Timer display 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears Press the NEXT key SPO2 SETUP OPTIONS appears Press the NEXT key SPO2 TIMERS appears dod ENS Press the HELD key DISPLAY HELD TIMER appears The current setting flashes 5 Press ON or OFF as desired SPO2 TIMERS reappears ON allows the timer to be displayed in the Message Center OFF prevents the timer from being displayed 6 Press RUN to return to the Main Menu Special Alert Delay The Special Alert Delay alert feature allows the user to adjust the time interval between the occurrence of special conditions and the activation of audible and visible alerts Special alerts include Low Signal Strength Light Interference and Insufficient Light These conditions are usually transitory in nature and allowing the user to vary the delay before alarm activa
96. em 100 per box Use on neonatal foot and hand or on pediatric toe or finger 20mm tapes use Blue color coded liners 25mm Wrap Style Taping System 100 per box Use on neonatal foot and hand 25mm tapes use Green color coded liners 20mm Finger Style Taping System 100 per box Use on pediatric finger or on small adult finger 20mm tapes use Blue color coded liners 25mm Finger Style Taping System 100 per box Use on adult finger 25mm tapes use Green color coded liners Adhesive Foam Wraps Large 25 per box Adhesive Foam Wraps Small 25 per box Non Adhesive Foam Wraps Large 25 per box Non Adhesive Foam Wraps Small 25 per box Ear Clips 5 per box Ear Clips 25 per box Adhesive Dots 250 per box OTHER SpO SENSORS SuperBright Finger Sensor 10 ft sensor cable SuperBright Y Sensor 10 ft sensor cable Special Use SuperBright Finger Sensor 8 inch sensor cable Special Use SuperBright Finger Sensor amp 25 ft shielded cable PRINTERS Seiko DPU 414 Thermal Printer with battery pack Hewlett Packard ThinkJet Printer discontinued Cable to Seiko DPU 414 Printer 9 to 15 pin Model 511M Cable to Seiko DPU 414 Printer 9 to 25 pin Model 515A 520A 860 1265 7 100 CO SMO User s Manual 119 Section 17 Catalog No 9086 00 5331 300013 300014 300017 400051 400052 400053 400054 6064 00 5962 00 6062 00 6065 0
97. entry module indicates the mains voltage setting for the monitor Check that the voltage is correct before attaching the AC line cord and powering the monitor The COSMO can be set to operate from 100 120 VAC 50 60Hz or 200 240VAC 50 60Hz Instructions for fuse replacement and changing the mains voltage setting follow Replace fuses with same type and rating Verify proper fuse value for mains voltage setting see table below Fuse Replacement 1 Check that the monitor is OFF 2 Set the rear panel power entry module switch to OFF O Remove the AC line cord from the power entry module 3 Using a flat blade screwdriver pry the fuse access door open to expose the fuse housing Note the orientation of the fuse housing this determines the mains operating voltage Mains Voltage Fuses Slo Blo 100 120 Vac 0 5 A 250V 200 240 Vac 250mA 250V Power entry module Fuse housing Fuse access door Rev 04 CO SMO User s Manual 113 Section 15 Mains Voltage Configuration 4 Pry the fuse housing out from the power entry module Fuse housing NOTE 5 mm X 20 mm fuses are installed toward the back of the fuse housing as shown 3AG type 5 X 20mm type 5 Replace the blown fuse s with the proper type and rating 6 Reinstall the fuse housing When positioning the housing into the power entry module make sure
98. ess RUN to return to the Main Menu Alert Limit Settings Retained Defaults When CO5SMO is turned on it restores the Retained alert limit settings that were in effect when the monitor was last turned off However the monitor can be configured to use its default alert limit values at each power up instead 64 co swo User s Manual Rev 04 Limit Alerts Delayed Instant Alerts Rev 04 To use Retained or Default alert limit settings at power up Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS is displayed Repeatedly press the NEXT key until ALERT OPTIONS 1 appears Press DFLT default and RETAIN ALERT LIMITS appears The current setting flashes Press YES or NO as desired YES CO SMO powers up using the alert limit settings from the previous use NO At power up uses default alert limits ETCO 55 25 Respiratory Rate 120 5 SpO 100 85 and Pulse Rate 150 40 NOTE Once the choice of Retained or Default alert limit settings is made that choice will remain in effect even if the monitor is turned off and on until changed by the user ALERT OPTIONS 1 reappears Press RUN to return to the Main Menu Limit Alerts Delayed Instant When a parameter violates an alert limit the f or limit display and the JL indicator start to flash immediately but the audible alarm and Alert Bar if enabled are delayed 10 seconds This delay helps avoid nuisance alarms because if during that first ten
99. evation in the baseline with a corresponding increase in End Tidal CO It indicates the rebreathing of the previously exhaled CO Possible Causes e Insufficient expiratory time e Faulty expiratory valve e Inadequate inspiratory flow e Malfunction of a CO absorber system e Partial rebreathing circuits Rev 04 CO SMO User s Manual 125 Section 18 Obstruction in Breathing Circuit or Airway Obstruction in Breathing Circuit or Airway An obstruction to the expiratory gas flow noted as a change in the slope of the ascending limb of the capnogram The expiratory portion may diminish without a plateau Possible Causes e Partial obstruction in the expiratory limb of the breathing circuit e Presence of a foreign body in the upper airway e Partially kinked or occluded artificial airway e Herniated endotracheal tracheostomy tube cuff e Bronchospasm Endotracheal Tube Kinked Kinking 1 Waveform Evaluation e Any obstruction will cause an abrupt change in the ascending limb resulting in either a diminished plateau or no plateau ETCO and slope will depend on the degree of obstruction 126 co swo User s Manual Rev 04 Inadequate Seal Around Endothracheal Tube Typical Capnogram Waveforms Inadequate Seal Around Endothracheal Tube A capnogram in which the downward slope of the plateau blends in with the descending limb Possible Causes e A leaky or deflated endotracheal or tracheostomy cuff e An artificial airway that is t
100. f the release liner m Peel off paper UP e ee Rev 04 CO SMO User s Manual 43 Section 6 Adhesive Foam Wraps 3 Face the blue side of the wrap toward the skin and wrap around the site If using the neonatal pediatric foam wrap Velcro tab may be removed and replaced to allow excess foam to be cut as necessary Secure with the Velcro tab WARNING Do not wrap around the limb so tightly that circulation is restricted Inspect the site often at least once every four hours for adequate circulation 4 Ensure the sensor heads are directly opposite each other through the tissue This prevents the sensor from being placed on a site too thick for proper operation CATALOG NO 6968 NEONATAL PEDIATRIC Neonatal hand a S Neonatal pediatric foot Pediatric toe CATALOG NO 6929 LARGE Adult pediatric finger iis Adult toe WARNING Treat foam wrap in accordance with hospital protocol for single patient use Check site regularly to ensure adequate circulation and proper sensor positioning 44 CO SMO User s Manual Rev 04 Y Sensor Application using Ear Clip SpO2 Sensors Y Sensor Application using Ear Clip 1 Remove center strip from the Y Sensor Sensor Heads 2 Slide each Y Sensor head into the ear clip s receptacles the heads should face each other eee Sensor Head Ch Sensor cable fits in groove on clip Ear Clip Receptacle Squeeze here to apply gt d
101. f while it is writing the new settings to memory Wait until DIP SW setting complete is printed then the printer power may be turned off Connecting the Seiko DPU 411 Printer The Seiko DPU 411 thermal printer Cat No 5702 00 for 120 vac 5703 00 for 220 vac can be used with the COSMO for trend or tabular printouts The Seiko DPU 411 printer and the CO SMO must be correctly configured before they can operate properly An interface cable connects the two devices Rev 04 CO SMO User s Manual 87 Section 13 Selecting a Specific Printer Interface cable Catalog No 5861 00 is twelve inches long and allows the Seiko DPU 411 printer to be powered from the CO SMO The printer s AC adapter is not needed Interface cable Catalog No 6887 00 is a six foot cable that requires the Seiko DPU 411 printer to be powered from its AC adapter To configure and connect the Seiko DPU 411 thermal printer 1 Ensure that the printer is off 2 Set the DIP switches on the bottom of the DPU 411 to the proper settings First set of eight switches 1 2 OFF 3 4 ON 5 6 OFF 7 8 ON Second set of six switches 1 3 ON 4 6 OFF dannannn nonoun Seiko Model 411 DPU bottom NOVAMETRIX m VESICAL SYSIENS INC Eta Cerified lo cc ply with the limits for c Class B camputing device pursuant to Subpart J of Pert I5 cf fcc Rules Sec irslructions if interference lp rcdio reception is suspected 3 Connect a printer interface cable bet
102. factory to display the highest ETCO value measured during the most recent ten seconds of patient monitoring This sliding ten second calculation period can be extended to 20 seconds One breath averaging where the ETCO value of each breath is displayed can also be selected ETCO calculation does not affect Respiratory Rate To view or alter the ETCO calculation time 1 Press the MENU key CO2 OPTIONS appears Rev 04 CO SMO User s Manual 31 Section 5 Carbon Dioxide 2 Press the NEXT key SYSTEM OPTIONS appears 3 Press the AVG averaging key AVERAGING SELECTIONS appears 4 Press the CO2 key SELECT ETCO2 AVERAGING appears The current setting flashes 5 Press 1BR 10s or 20s as desired Press 1BR to select breath by breath ETCO display Press 10s to display the highest ETCO value within the most recent 10 seconds Press 20s to display the highest ETCO value within the most recent 20 seconds 6 Press RUN to return to the Main Menu Inspired COs CO concentrations measured during inspiration are typically close to 0 mmHg Rebreathing whether intentional or not tends to raise the minimum concentration of CO CO SMO automatically displays Inspired CO if the minimum detected concentration of CO is in excess of 3 mmHg for periods longer than 15 seconds CO SMO displays Inspired CO in the form of INSPZXX where XX is the concentration of CO There are no alerts for Inspired CO Inspired COs
103. g High limit above 249 or the Low limit below 30 If the Pulse Rate limits are off the limits display OFF and no Pulse Rate limit alerts are generated To manually set the alert limits 1 Press the ALRT key SET ALERT LIMITS appears 2 Press SEL select to move to the limit to be changed 3 Press T or 4 to increase or decrease the selected limit 62 co sMO User s Manual Rev 04 Alert Volume Alerts Press and release the arrow keys to change the limit value up or down by one Press and hold the arrow keys to make the value change more rapidly NOTE COSMO will not allow a parameter s high and low alert limits to be set to within 5 digits of each other For example using default values if the lower Respiratory Rate limit is increased to 116 the upper limit will change from 120 to 121 in order to maintain the 5 digit difference between limits 4 Once all limits are set as desired press RUN Alert Volume The volume of the monitor s audible alert is user adjustable The alert volume feature cannot be used to eliminate audible alerts because the alert is still audible at its lowest setting Use the Two Minute Silence or Audio features to silence audible alerts See AUDIO Key on page 7 To vary the audible alert volume 1 Press the MENU key CO2 OPTIONS appears Press the NEXT key SYSTEM OPTIONS appears Press the AUDIO softkey SET AUDIO FEATURES appears dor als Press the ALRT key ALERT V
104. g No 8793 or 8791 Select a foam wrap based on the patient type e Catalog No 8836 Large adult pediatric finger neonatal pediatric foot or hand e Catalog No 8943 Small neonatal foot or hand pediatric toe or finger To use the non adhesive foam wrap 1 With the blue side of the foam wrap facing up press the buttons on the back of each Y sensor head through the holes in the foam wrap The wrap will stretch to fit the buttons Head Head Pesce Y Sensor Center Strip may be removed Blue Foam Y lt Cross section of Sensor head da White Fabric in the foam wrap Center strip removed Rev 04 CO SMO User s Manual 41 Section 6 Non Adhesive Foam Wrap If using the first and third holes on the foam wrap it may be necessary to cut the middle strip off the Y sensor 2 Face the blue side of the wrap toward the skin and wrap around the site cut excess foam if necessary on small version Secure with the Velcro tab Do not wrap the tape around the limb so tightly that circulation is restricted Inspect the site often for adequate circulation at least once every four hours 3 Ensure the sensor heads are directly opposite each other through the tissue This prevents the sensor from being placed on a site too thick for proper operation CATALOG NO 8943 SMALL Neonatal hand oe Neonatal pediatric foot Pediatric toe CATALOG NO 8836 LARGE p
105. gain starts to receive valid plethysmogram data from the sensor at which point the saturation and pulse rate displays will re enable the error message will disappear and the audible and visible alerts will stop e H at any time before the SPO2 BAD SIGNAL message appears the monitor receives good signals the timers are reset and no alerts occur To determine or alter the current setting of the Bad Signal Timer 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears Press the NEXT key SPO2 SETUP OPTIONS appears Press the NEXT key SPO2 TIMERS appears en Sin at Press the BAD key and ALERT ON BAD SIGNAL appears The current setting flashes ke Press Os 15s 30s 60s as desired SPO2 TIMERS reappears Os for no delay 15s for 15 second delay 30s for 30 second delay 60s for 60 second delay 6 Press RUN to return to the Main Menu Note however that other alerts Low Signal Strength Light Interference Insufficient Light Probe Off Patient etc may activate prior to the SPO2 BAD SIGNAL These alerts also serve to notify the user that a potentially adverse situation exists Rev 04 CO SMO User s Manual 55 Section 7 IABP Mode IABP Mode COSMO uses advanced signal processing algorithms to distinguish valid pulsatile signals from signals generated by motion or other artifact Motion artifact very common in all but heavily sedated patients can swamp the true pulsatile signal or distort it enough to pr
106. gital detection algorithm to react to non respiratory CO fluctuations as if they were breaths This condition may cause the monitor s numerical Respiratory Rate display to show values greater than the actual Respiratory Rate The Capnogram display continues to provide an accurate CO signal The Respiratory Rate Editor can be enabled by the user to add additional adaptive waveform duration and amplitude criteria to the detection algorithm Use of the Respiratory Rate Editor makes the monitor more selective in its differentiation of waveforms caused by breathing and those introduced by artifact As a result when the editor is in use the monitor will adapt slowly to sudden changes in respiratory rate To insure the maximum possible sensitivity to changing respiratory rates it is recommended that the Respiratory Rate Editor be used only in situations in which non respiratory CO fluctuations visible in the Capnogram display are observed to affect the numerical Respiratory Rate display When the Respiratory Rate Editor is active EDIT appears below the respiratory rate display in place of the br m legend 34 co sMO User s Manual Rev 04 Capnogram Monitoring CO and Respiratory Rate Resp Rate Editor Icon To turn the Respiratory Rate Editor on or off 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Press the EDIT key RESP RATE EDITOR appears The current status of the Respiratory Rate Editor
107. he bed rail e Incase of interference with our equipment or another manufacturer s equipment notify your Novametrix representative e Do NOT attach an SpO sensor distal to a blood pressure cuff Valid data CANNOT be processed when the cuff is inflated Attach the sensor to the limb opposite to the site used for the blood pressure cuff e Care should be exercised to assure continued peripheral perfusion distal to the SpO sensor site after application 12 co swO User s Manual Rev 04 Cautions Patient Safety e Do not store the monitor or sensors at temperatures less than 14 F 10 C or greater than 131 F 55 C e Do not operate the monitor or sensors at temperatures less than 50 F 10 C or greater than 104 F 40 C e Caution Federal U S A law restricts this device to sale distribution or use by or on the order of a licensed medical practitioner NOTES Indicates points of particular interest or emphasis for more efficient or convenient operation e Components of this product and its associated accessories which have patient contact are free of latex e After the life cycle of our equipment and all accessories has been met disposal of the equipment should be accomplished following the national requirements Contact the local Novametrix representative for questions concerning disposal Rev 04 CO SMO User s Manual 13 Section 2 Cautions This page intentionally blank 14 co swO User
108. ide V Service Policy Novametrix Medical Systems Inc will provide Warranty Service Support to its customers within 48 hours of receiving a telephone request for technical support This 48 hour period begins once a service request is placed through the Factory Technical Support Department in Wallingford Connecticut Novametrix provides factory direct technical support to its customers through a technical support group located in Wallingford Connecticut and company service representatives located throughout the United States All Technical Support for Novametrix products is provided Factory Direct Novametrix provides 24 hour a day technical support accessibility via telephone numbers 800 243 3444 or 203 265 7701 After hours technical support requests before 8 00 AM and after 5 00 PM Eastern Time will be responded to promptly by the Technical Support On Call staff It is suggested that any person calling in for technical support have the inoperative equipment available for preliminary troubleshooting as well as product identification Novametrix reserves the right to repair or replace any product found to be defective during the warranty period Repair may be provided in the form of replacement exchange parts or accessories on site technical repair assistance or complete system exchanges Repairs provided due to product abuse or misuse will be considered non warranty and invoiced at the prevailing service rate Any replaced defecti
109. ield Clears Patient ID field Y WAVEFORM FROZEN RUN PRINT MAIN AA STORE WAVEFORM TO CARD Y RUN STORE ID ERASE PRINTOUT STARTED MAIN MAIN AA PATIENT ID m SET CLR SELECT T Yes To WRITE TO CHECKING CALIBRATION v CALIBRATION VERIFIED REMOVE SENSOR FROM CELL y ERASE NOVACARD YES NO CANNOT ERASE THIS CARD Place Capnostat on Reference Cell without Zero calibration first v TRENDS RETAINED ERASING NOVACARD PLEASE WAIT e STORING WAVEFORM TO CARD PLEASE WAIT NOT CALIBRATED PLACE ON ZERO CELL Appears when monitor is powered up for factory default settings PARAMETERS RESET TO FACTORY DEFAULTS No WAIT FOR SENSOR CANCEL Wait for warmup Yes Breaths BREATHS DETECTED Detected TIME REMAINING XX CANCEL No CALIBRATION ERROR CONT Yes A Zero Successful CO SMO Menu Tree Revision 2 9 Software Page 3 of 4 MENU Y Holdfor3seconds l P RUN CO2 SETUP OPTIONS RUN BARO EDIT UNITS NEXT BARO PRESSURE XXXmmHg AUTO MANUAL PREV cay AUTOMATIC BARO PRESSURE COMPENSATION SELECTED 3 BARO PRESSURE XXXmmHg RUN RN
110. imit Alert Status Percent of monitoring time spent above below and within the parameter alert limits as shown on the printout Histogram Data A numerical and graphical display of the percentage of monitoring time non monitoring time excluded spent in each of the ranges listed Average Min and Max The minimum and maximum recorded values Average refers to the arithematic mean of all readings End of Trend Printout Message shows Histogram is a part of the Print Trend feature Tabular Data Format Tabular Mode Text Printouts start off with a Header refer to previous section followed text printed at 30 seconds intervals The format of the tabular text is HH MM SS SpO2 XXX PULSE XXX bpm ETCO2 XXX mmHg RR XXX BR M INSP XXX mmHg 94 co sMO User s Manual Rev 04 Interpreting Printer Output Using a Printer Rev 04 where HH MM SS is the hour minute and seconds 24 hour format and XXX is the appropriate displayed parameter value NOVAMETRIX MEDICAL SYSTEMS INC COSMO ETCOZ SP02 MONITOR PRINTED AT 15 21 5 MAR71993 Header PATIENT NAME NOTES TABULAR MODE m 15 21 30 SpO2 97 PULSE 73 bpm ETCO2 4 mmHa RR 23 BRM INSP D mmHs 15 22 08 SP02 97 PULSE 74 bem ETCO2 d mmHa RR 23 BRM Time and INSP mmHs Parameters 15 22 38 Se02 97 PULSE 75 bem printed every ETCO2 d mmHo RR 23 BRM 30 seconds INSP D mmHs 15 23 08 SP02 97 PULSE 82 bem ETCO2 48 mmHa RR
111. in stored trend information ERASE STORED TRENDS is briefly displayed after power on Press YES to erase the trend data stored during previous monitoring episodes To keep the stored trend data intact press the NO key or don t press any key and let the menu time out Rev 04 CO SMO User s Manual 15 Section 3 Monitor Power Down Monitor Power Down 1 To turn CO SMO off press both the and keys To turn CO SMO off while only one parameter is active press the power key associated with the active parameter AC Mains Operation COSMO uses AC Mains line cord power if available and automatically switches to battery operation if AC Mains power is removed or not present An illuminated AC ON v indicator means the COSMO is connected to AC Mains power and the internal battery is being charged To power COSMO from AC Mains line cord power Plug the line cord into the rear panel AC input connector Set the rear panel power switch to the I ON position Plug the other end of the line cord to a properly grounded three wire outlet Battery Operation CO SMO uses battery power if the line cord is disconnected or the rear panel power switch is set to the O OFF position CO SMO can operate up to two hours from its internal battery While on battery power COSMO displays a battery icon to the right of the numerical Respiration display iili indicates a fully charged battery mm a half charge and indicates less than 30 min
112. ing release liner s and apply the sensor tape to the patient Ensure that the sensor heads are directly opposite each other through the tissue This prevents the sensor from being placed on a site too thick high arch for proper operation Position the sensor so that the tape does not extend over the space between the fingers or toes to insure there will be no light transmission through this space Do not wrap the tape around the limb so tightly that circulation is restricted Inspect the site often for adequate circulation at least once every four hours Care should be exercised to ensure clinically reasonable alert limit settings are selected Novametrix does not recommend the setting of limit values to such a wide span as to effectively render alert limit feature useless Once the limit values are properly set the user should periodically confirm patient status by alternate means and not rely soley on alerts generated when a limit is violated 6 To maximize sensor life secure the sensor to the patient with additional tape Leave slack in the wires between the tape and the sensor 40 co sMO User s Manual Rev 04 Non Adhesive Foam Wrap SpO2 Sensors Adult Pediatric Finger Pediatric Toe Neonatal Pediatric Foot Neonatal Hand 7 Inspect the site often for adequate circulation at least once every four hours Non Adhesive Foam Wrap Use the non adhesive foam wrap with Novametrix SpO Y Sensor s catalo
113. inter COSMO directly supports specific RS232 serial printers They include the Seiko DPU 414 and DPU 411 Thermal Printers and the Hewlett Packard ThinkJet Printer The information output by the printers is the same However due to printer differences the format of the printed information will vary slightly between printers Selecting a Specific Printer The COSMO must be set to the appropriate printer interface 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTIONS 2 appears 3 Press the SER serial interface key and the currently selected interface appears Available interfaces include INTERFACE UNUSED PRINTER INTERFACE NOVACOM 1 INTERFACE ANALOG MODULE INTERFACE NOVACARD INTERFACE TELECAP INTERFACE and TELESAT INTERFACE 4 Press PREV previous or NEXT to select PRINTER INTERFACE 5 Press the SET key SELECT PRINTER TYPE appears The currently selected printer type flashes 6 Press the SEIKO or TJET key as desired 7 Press RUN to return to the Main Menu When Printer Interface Mode is selected a PRNT print softkey is added to the SYSTEM OPTIONS and TREND OPTIONS menus Connecting the Seiko DPU 414 Thermal Printer To connect a Seiko DPU 414 Thermal Printer PN 9140 00 to the CO SMO 1 Connect the 9085 00 interface cable to the monitor s RS232 connector and to the printer s serial input connector the 9 pin D connector 2 Co
114. ions Cardiogenic oscillations appear during the final phase of the alveolar plateau and during the descending limb They are caused by the heart beating against the lungs Capnogram Characteristics e Rhythmic and equal to heart rate e May be observed in pediatric patients mechanically ventilated at low respiratory rates with prolonged expiratory times Rev 04 CO SMO User s Manual 123 Section 18 Hypoventilation Hypoventilation An increase in the level of the End Tidal CO from previous levels Hypoventilation yp x Possible Causes e Decrease in respiratory rate e Decrease in tidal volume e Increase in metabolic rate e Rapid rise in body temperature malignant hyperthermia Hyperventilation An decrease in the level of the End Tidal CO from previous levels Hyperventilation Possible Causes e Increase in respiratory rate e Increase in tidal volume e Decrease in metabolic rate e Fall in body temperature 124 co swo User s Manual Rev 04 Muscle Relaxants Typical Capnogram Waveforms Muscle Relaxants Clefts are seen in the final third portion of the alveolar plateau They appear when the action of the muscle relaxants are affected by spontaneous ventilation Characteristics e Depth of the cleft is inversely proportional to the degree of drug activity e Position fairly constant on same patient but may not be present in every capnogram Rebreathing Rebreathing is characterized by an el
115. irway adapter between the ET tube and the elbow as this may allow patient secretions to block the adapter windows e Position the Airway Adapter with its windows in a vertical and NOT a horizontal position This helps keep patient secretions from pooling on the windows If pooling does occur the airway adapter may be removed from the circuit rinsed with water and reinserted into the circuit e To prevent rain out and moisture from draining into the Airway Adapter do NOT place the Airway Adapter in a gravity dependent position 5 Check that the connections have been made correctly by verifying a proper CO waveform capnogram on the monitor display 6 The sensor cable should face away from the patient 18 co swO User s Manual Rev 04 Single Patient Use Adult Airway Adapter CAPNOSTAT CO Sensor To secure the sensor cable safely out of the way attach Sensor Cable Holding Clips to the airway tubing then connect the sensor cable to the clips Cat No 8751 7 See Monitoring CO and Respiratory Rate on page 29 Single Patient Use Adult Airway Adapter The Single Patient Use Adult Airway Adapter Catalog No 6063 should be used when monitoring patients with Endotracheal Tube diameters greater than 4 0 mm Alternatively the reusable Adult Airway Adapter Catalog No 7007 may be used See Adult Airway Adapter on page 17 The Single Patient Use Adult Airway Adapter is intended for single patient use do not re use
116. le Neonatal Airway Adapter The Neonatal Airway Adapter Cat No 7053 may be cleaned by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant or pasteurized or cold sterilized gluteraldehyde It should then be rinsed out with sterile water and dried 110 co swo User s Manual Rev 04 Cleaning and Sterilization Maintenance Rev 04 e The Neonatal Airway Adapter Cat No 7053 may be sterilized by ETO ethylene oxide gas Be sure to use appropriate aeration times Before reusing the adapter ensure the windows are dry and residue free and that the adapter has not been damaged during handling or by the cleaning sterilization process External Sampling System Components e The Nasal Sampling Cannulas are single patient use e The Sampling Airway Adapter with tubing Cat No 5843 may be cleaned by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant It should then be rinsed out with sterile water and dried Single Patient Use Airway Adapters e Treat all single patient use airway adapters in accordance with hospital protocol for single patient use items Internal Sampling System Components Acceptable fluids for cleaning sterilizing the internal pneumatic parts of the Sampling System include Isopropyl alcohol Cidex or equivalent or a 5 25 water solution by weight of sodium hypochlorite bleach CAUTION Do not attempt to pump cleaning sterilizing liquid with the
117. lerts are provided for ETCO See Alerts on page 59 Oxygen Compensation Unless compensated for the presence of oxygen at elevated concentrations affects the measurement of the concentration of CO Typically unless compensated for oxygen levels in excess of 60 tend to decrease the displayed CO value by approximately 5 of reading COSMO allows the user to enable O5 Compensation if oxygen levels in excess of 60 are introduced to the airway circuit O Compensation should be turned off if the O5 concentration is less than 60 When O Compensation is active O2 is displayed below the respiration rate display Rev 04 CO SMO User s Manual 29 Section 5 Carbon Dioxide O2 Indicator z H B 60 E gt 60 bem OH OFF To turn O5 Compensation on or off 1 Press the MENU key CO2 OPTIONS appears 2 Press the O2 key O2 COMPENSATION gt 60 appears The current setting flashes 3 Press ON or OFF as desired Press ON to activate O9 Compensation The O2 icon is displayed Press OFF to turn off O Compensation The O2 icon display is removed 4 Press RUN to return to the Main Menu Nitrous Oxide Compensation Unless compensated for the presence of nitrous oxide affects the measurement of the concentration of CO Typically unless compensated for nitrous oxide in concentrations of 50 70 tend to increase the displayed CO value by approximately 5 of reading CO SMO allows the user to enable N O Com
118. ls produce a tall SIGNAL bar while weak pulsatile signals produce a correspondingly shorter bar Typical signals are 25 75 of the signal bar height The SIGNAL bar is shown only in the Plethysmogram display not in dual waveform mode If necessary press to display the plethysmogram and signal bar Plethysmogram Display COSMO displays a plethysmogram a representation of the pulsatile waveform as detected by the SpO sensor If necessary press El to display the plethysmogram and signal bar The display is continually updated from left to right The monitor automatically adjusts the vertical size of the plethysmogram to best fit the display area maximizing viewability of the waveform However this means the waveform gives no indication of pulsitile signal magnitude Refer to the Signal Bar Waveform Autosize The Waveform Autosize feature can be turned off if the user wants the plethysmogram magnitude to reflect detected signal strength NOTE If the plethysmogram is displayed and Plethysmogram Autosize is set to OFF a SIZE key is displayed in the Main Menu COSMO User s Manual Rev 04 SpO Timers Rev 04 Monitoring SpO and Pulse Rate To turn the Plethysmogram Autosize feature on or off Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears Press the NEXT key SpO2 SETUP OPTIONS appears Press the SIZE key PLETH AUTOSIZE appears The current setting flashes Press ON or OFF as de
119. made that choice remains in effect even if the monitor is turned off and on until changed by the user 5 ALERT OPTIONS 1 reappears Press RUN to return to the Main Menu Limit Alerts Latched Unlatched Alerts caused by parameters violating alert limit settings are normally Latched Once a latched alert is active for 10 seconds even if the parameter then returns within its limits the tor V indicator and the A indicator continue to flash until the user presses the key This indicates which parameter caused the alert COSMO also supports Unlatched alerts that automatically stop the flashing of the f or and A indicators as soon as the alerting parameter returns within its limits The user does not have to press the key when unlatched alerts are in use To select Latched or Unlatched alerts 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS is displayed 2 Repeatedly press the NEXT key until ALERT OPTIONS 1 appears 3 Press LATCH and ALERTS LATCHED appears The current setting flashes 4 Press YES or NO as desired YES provides latched alerts that require the user to press the key to clear them NO provides unlatched alerts that reset automatically without user intervention NOTE Once the choice of Latched or Unlatched alerts is made that choice will remain in effect even if the monitor is turned off and on until changed by the user 5 ALERT OPTIONS 1 reappears Pr
120. ndicators stop flashing If the limit alert lasts for longer than 10 second Anaudible alarm will sound e The Alert Bar to the right of the display starts to flash e The violated limit becomes latched If the parameter returns within limits after 10 seconds of continual alerting e The audible alarm will turn off e The Alert Bar will stop flashing e The A and f or indicators continue to flash until the user presses the key this allows the user to determine which limit was violated Auto Alert Limits Auto Alerts allow bracketing of the alert limits based on recent patient data To set Auto Alert Limits 1 Press the f nt er key SET ALERT LIMITS appears 2 Press the AUTO softkey COSMO sets the alert limits automatically One of the following messages will be briefly displayed e AUTOLIMITS SET The ETCO resp rate SpO and pulse rate alert limits have successfully been set to reflect current patient status e NOT ENOUGH DATA TO SET ETCO2 LIMITS SpO and Pulse Rate alert limits have successfully been set to reflect current patient status but ETCO and Resp Rate alert limits have not been changed Ensure the Capnostat is connected to the airway circuit and at least three breaths have been recorded then press AUTO again e NOT ENOUGH DATA TO SET SpO2 LIMITS ETCO and Resp Rate alert limits have successfully been set to reflect current patient status but SpO and Pulse Rate alert limits have not been changed E
121. nfigured for operation with the VOVACARD memory module and the key is pressed STORE WAVEFORM will be displayed for 60 seconds Pressing the STORE key will store the Based on factory default settings Rev 04 Front Panel Controls and Connectors Introduction waveform to the NOVACARD Pressing ID will bring up the patient ID menu The ERASE softkey will erase the card Pressing RUN will return to real time display EUEHT MARKED CONTRAST Key Press the contrast key to adjust the display for optimum viewing WAVEFORM Key Press key to display the capnogram plethysmogram or dual waveform Red Alert Bar The Red Alert Bar flashes when an alert occurs The bar can be set to latched where the bar flashes until the presses ALERT RESET unlatched the bar stops flashing when the alerting parameter returns inside its limits or off where the bar will not turn on at all CAPNOSTAT CO Sensor Input Connector The CAPNOSTAT CO Sensor plugs into this connector Connect only a Novametrix Catalog No 7167 CAPNOSTAT CO Sensor to the CO SMO CO Input Connector Do not use other CO sensors with the CO SMO An INCOMPATIBLE CO2 SENSOR message indicates a non compatible sensor is connected Sampling System Inlet Connector The Sampling Airway Adapter tubing plugs into this connector Rev 04 CO SMO User s Manual 9 Section 1 Rear Panel Controls and Connectors Rear Panel Controls
122. nnect the AC adapter and turn the printer on 1 See Analog Output Module on page 71 for details on analog type printers and recorders 2 Only the Seiko DPU 414 Thermal Printer is currently available Information on the Seiko DPU 411 and HP Thinkjet printers remains for backward compatibility Rev 04 CO SMO User s Manual 85 Section 13 Selecting a Specific Printer Configuring the Seiko DPU 414 Printer The Seiko DPU 414 Thermal Printer Cat No 9140 00 must be configured to communicate with the COSMO When properly configured the Seiko printer will retain the settings even when turned off Top view Rear view SERIAL PARALLEL tj e lt lt e a DPU 414 THERMAL PRINTER OFF LINE PAPER END Serial connection AC adapter ON LINE FEED On Off switch Setting the DIP switches 1 Slide the printer s power switch to OFF O 2 Press and hold the ON LINE button then slide the power switch ON I Release the ON LINE button after the list of current settings starts printing out 3 The printout of the current settings is followed by the prompt Continue Push On line SW Write Push Paper feed SW To change the DIP switch settings push the ON LINE button to leave the DIP switch settings unchanged push the FEED button 4 DIP SW 1 will print Enter the new settings for switches 1 8 ON
123. nsure the SpO sensor is correctly applied to the patient and SpO and pulse rate values are being displayed then press AUTO again e NOT ENOUGH DATA TO SET ETCO2 AND SpC2 LIMITS Both ETCO2 and SpO2 alert limits have not been changed Ensure the Capnostat is connected to the airway circuit and at least three breaths have been recorded also the SpO sensor is correctly applied to the patient and SpO and pulse rate values are being displayed Then press AUTO again 60 CO0 SMO User s Manual Rev 04 Auto Alert Limits Alerts WARNING Once the limit values are set the user should periodically confirm patient status by alternate means and not rely solely on alerts generated when a limit is violated 3 SET ALERT LIMITS reappears Press RUN to return to the Main Menu ETCO gt Auto Alert Limits The ETCO auto alert limits are derived from the average of the three most recent ETCO values recorded before AUTO was selected The average then falls into one of two ranges that define the high and low limits Those ranges are ETCO High Low Average Limit Limit 1 40 mmHg 25 of value 25 of value gt 40 mmHg 10 mmHg 10 mmHg A If ETCO is displayePa or percent not mmHg the limits are based on the equivalent of mmHg For example if the average of the three most recent ETCO values recorded before AUTO was pushed was 32 mmHg the upper alert limit is set to 40 32 25 32 x 1 25 40 and
124. ntains a code that identifies the format of the information contained in the EEPROM If the code is not recognized by the monitor s software this message will occur If this message occurs return the sensor to the factory for servicing CO SMO User s Manual 81 Section 12 82 Message Displayed Possible Explanation PLACE ON ZERO CELL A calibration error has been detected or a new sensor has been connected Place the sensor on the zero cell to recalibrate CO2 ADAPTER CAL ERR Error detected during Adapter cal This will occur if Airway Adapter is not connected or if CO gas is present in the Airway Adapter during airway zero Perform an adapter calibration to correct if problem persists a possible hardware error exists ETCO2 OUT OF RANGE The value being calculated is greater than 100mmHg If error persists check calibration and perform a zero calibration if necessary NOT CALIBRATED PLACE ON ZERO CELL An uncalibrated sensor has been placed on the reference cell before having been zero calibrated on the zero cell CHECK SAMPLING LINE The monitor has detected a leak in the sampling system SAMPLE LINE BLOCKED Indicates line blockage in the sampling system CAL CO2 CANNULA Displayed when sampling system pump is turned on Calibration necessary for proper operation of sensor and pump current monitoring BARO PRESSURE ERROR Monitor detects invalid readings from the ba
125. nu refer to the previous section IABP Mode can be turned on or off as desired To turn IABP MODE on or off Press the MENU key CO2 OPTIONS appears Press the NEXT key SYSTEM OPTIONS appears Press the AVG averaging key AVERAGING SELECTIONS appears Press the IABP key SELECT IABP MODE appears The current setting flashes Press ON or OFF as desired ON IABP Mode is turned on The message IABP appears below the pulse rate display OFF IABP Mode is turned off NOTE While availability of IABP Mode to the Main Menu is retained in memory and restored each time the monitor is turned on COSMO always powers up with IABP Mode turned off The user must intentionally select IABP Mode from the AVERAGING SELECTIONS menu AVERAGING SELECTIONS reappears Press RUN to return to the Main Menu Using IABP Mode When IABP Mode is turned on the message IABP appears below the pulse rate display WARNING With IABP Mode turned on the clinician must exercise prudence in assessing the validity of the SpO and Pulse Rate displays because any motion or other artifact not just that associated with the IABP can have a significant affect on the SpO and Pulse Rate calculations While in IABP Mode the displayed Pulse Rate reflects true pulsatile signal heart rate plus the IABP ratio Example 1 heart rate 120 bpm IABP ratio 1 1 then displayed Pulse Rate should be 120 120 1 240 beats min Example 2 heart rate 1
126. o the prescribed O setting 9 Position the cannula on the patient Insert the cannula tips into the nostrils pass the cannula tubing over the ears then slide the retaining sleeve up the tubing toward the neck to a comfortable fit under chin 10 Check the connections have been made properly by verifying a proper CO waveform capnogram on the monitor display 11 Using the CAPNOSTAT CO Sensor holding clip secure the sensor in a convenient place such as the on the patient s clothing or bedding NOTE If possible position the Sampling Adapter with its windows in a vertical and NOT a horizontal position this helps keep moisture from pooling on the windows If pooling does occur the airway adapter may be removed from the circuit rinsed with water and reinserted into the unit To prevent rain out and moisture from draining into the Sampling Adapter do NOT place the Sampling Adapter in a gravity dependent position 12 Use the twist clips to connect the sensor cable and sampling tubing together then place them out of the way 13 See Monitoring CO and Respiratory Rate on page 29 26 co sMO User s Manual Rev 04 Calibration Rev 04 CAPNOSTAT CO Sensor Calibration Sensor Calibration The CAPNOSTAT CO Sensor does NOT require calibration at each monitor power up Calibration of a particular CAPNOSTAT CO Sensor is necessary only when 1 the monitor requests calibration and 2 the fir
127. o the reference cell and within several seconds CALIBRATION VERIFIED should appear Adapter Calibration Adapter Calibration compensates for the optical differences between the Adult Neonatal and Sampling Airway Adapters Adapter Calibration needs to be performed each time you switch airway adapter types for example if you switch from using an Adult to a Neonatal adapter but not if you switch from an Adult adapter to another Adult adapter Adapter Calibration should also be performed if the monitor displays ADAPTER CAL or CAL CO2 CANNULA Refer to Adult Airway Adapter on page 17 Neonatal Airway Adapter on page 21 and Sampling Airway Adapter on page 25 for specific Adapter Calibration details 28 cCO 5MO User s Manual Rev 04 Section 5 Monitoring CO and Respiratory Rate Once the Capnostat CO Sensor and airway adapter are connected to the patient s airway circuit COSMO displays ETCO Inspired CO if present Respiratory Rate and a capnogram Carbon Dioxide CO5SMO s Carbon Dioxide display reflects the maximum concentration of CO detected during respiration This maximum CO concentration usually occurs at the end of expiration thus the term End Tidal CO or ETCO End Tidal CO CO5SMO measures ETCO in the range of 0 99 mmHg The system is accurate to 2 mmHg from 0 40 mmHg and to within 546 of the reading from 40 99 mmHg ETCO g 60 m ORT TRHD SCALE CAL MEHU Audible and visible limit a
128. oduce significant errors in the SpO and Pulse Rate calculations CO SMO s Validator algorithms reject distorted plethysmographic signals or those that lack a regular rhythmic pattern Therefore only valid i e pulsatile signals are allowed to affect the monitor s SpO and Pulse Rate calculations Unfortunately rare conditions exist where the pulsatile waveform truly is distorted and lacks a fixed rhythm specifically during use of an Intra Aortic Balloon Pump IABP During IABP procedures the pulsatile signal can be massively distorted without affecting the patient s SpO In order to accommodate these IABP procedures without compromising CO SMO s superior artifact rejection algorithm JABP Mode is available ABP Mode allows the user to turn off the Validator algorithm so that all pulsatile data including the normally rejected artifact generated by the IABP are allowed to influence the SpO and Pulse Rate calculations With IABP Mode turned on the clinician must exercise prudence in assessing the validity of the SpOs and Pulse Rate displays because any motion or other artifact not just that associated with the IABP can have a significant affect on the SpO and Pulse Rate calculations While in IABP Mode the displayed Pulse Rate reflects true pulsatile signal heart rate plus the IABP ratio Example 1 heart rate 120 bpm IABP ratio 1 1 then displayed Pulse Rate should be 120 120 1 240 beats min Example 2 heart rate
129. ogic conditions providing extremely poor plethysmogram signals will cause the BAD SIGNAL TIMEOUT message and alerts to activate The timer has selectable delay times of 0 15 30 or 60 seconds from the monitor s initial detection of the bad signal to activation of the alerts The Bad Signal Timer feature works in conjunction with the Display Held Timer and Special Alert Delay For example e Ifthe monitor detected and continued to receive bad signals from the sensor due to excessive motion etc the Display Held Timer would display if enabled at 10 seconds It would continue to count up until it reached the Special Alert Delay setting At this point the monitor s saturation and pulse rate display values would blank out and display The signal bar and plethysmogram will remain visible allowing evaluation of the patient pulsatile signal e Providing the monitor is still receiving bad signals from the sensor the timer display continues to count up to 99 seconds after which it remains at 99 Once the user selected 0 15 30 or 60 seconds bad signal delay has elapsed from the time the displays have blanked the message SPO2 BAD SIGNAL is displayed and the monitor s audible and visible alerts will activate providing they have not been previously disabled by the user The signal bar and plethysmogram will remain visible allowing evaluation of the patient pulsatile signal e This alert condition will remain active until CO SMO a
130. ogram data immediately prior to when the EVENT key was pressed Graphically the EVENT key press corresponds to the bottom of the printout the top of the printout is five seconds before EVENT was pressed The time SpO and Pulse Rate values are also printed The printed values reflect the monitor s display at the instant of printing NOVAMETRIX MEDICAL SYSTEMS INC COSMO ETCO2 8p02 MONITOR PRINTED AT 14 14 4 MAR 1998 Header PATIENT NAME NOTES Printout gt PLETHYSMOGRAM Identification SpO2 Parameters S88N0338 amp EVENT Key pressed E A o maa mam ae Ae a m CO SMO User s Manual 97 Section 13 Interpreting Printer Output This page intentionally blank 98 co sMO User s Manual Rev 04 Section 14 External Devices CO5SMO supports in addition to the printers previously mentioned specific external RS232 serial devices computer interface NOVACOM 1 Analog Module Memory Card NOVACARD Telecap and TeleSat For information on printers see Using a Printer on page 85 NOVACOM1 Interface The NOVACOM I interface is designed to output data in formats easily read by a computer or data logging device The computer interface provides the user several communication modes to choose from The communication format is 9600 baud 8 bits no parity 1 stop bit and XON XOFF handshaking Mode 1 Real Time In Real Time mode the end tidal CO respiratory rate and inspired C
131. oo small for the patient Endotracheal Tube in Esophagus Waveform Evaluation e A normal capnogram is the best available evidence that the ET tube is correctly positioned and that ventilation is occurring When the ET tube is placed in the esophagus either no CO is sensed or only small transient capnograms are present Faulty Ventilator Circuit Valve Waveform Evaluation e Baseline elevated e Sloping descending limb of capnogram e Allows patient to rebreathe exhaled gas Rev 04 CO SMO User s Manual 127 Section 18 Faulty Ventilator Circuit Valve This page intentionally blank 128 co swo User s Manual Rev 04
132. other one for back up If a sensor becomes inoperative place the back up sensor into use and return the inoperative sensor in the convenient pre paid mailer A replacement sensor will be shipped within two business days of receipt of the inoperative sensor This simple return replacement method will be used for the entire warranty period thereby guaranteeing your costs and virtually eliminating sensor tracking hassles Warranty The Plan warranty not individual sensors is 12 24 or 36 months Replacement sensors provided under terms of the Plan shall carry the remaining Plan warranty replacements do not extend the warranty 118 co swo User s Manual Rev 04 CO2SMO Capnograph and Pulse Oximeter Accessories Rev 04 Catalog No 8793 12 8793 24 8793 36 8744 24 8744 36 8828 8829 8831 8832 6929 6968 8836 8943 6131 50 6131 25 8700 8776 8791 8789 5238 9140 00 5140 00 9028 00 9085 00 Description Y 12 Plan The Plan warranty is 12 months Includes 3 boxes your choice of any Y Strip Taping Systems Y 24 Plan The Plan warranty is 24 months Includes 6 boxes your choice of any Y Strip Taping Systems Y 36 Plan The Plan warranty is 36 months Includes 9 boxes your choice of any Y Strip Taping Systems Finger 24 Plan The Plan warranty is 24 months Finger 36 Plan The Plan warranty is 36 months Y SENSOR APPLICATORS tapes wraps earclips 20mm Wrap Style Taping Syst
133. pensation if nitrous oxide is introduced to the airway circuit N O Compensation should be turned off if nitrous oxide is not present When N O Compensation is active N2O is displayed below the respiration rate display N20 indicator H20 COMPEHSHTIOH DN OFF To turn nitrous oxide compensation on or off 1 Press the MENU key CO2 OPTIONS appears 2 Press the N20 key N2O COMPENSATION appears The current setting flashes 3 Press ON or OFF as desired Press ON to activate N O Compensation The N20 icon is displayed Press OFF to turn off N O Compensation The N2O icon display is removed 4 Press RUN to return to the Main Menu 30 co sMO User s Manual Rev 04 Carbon Dioxide Monitoring CO and Respiratory Rate Barometric Pressure Compensation Barometric pressure changes changes in base altitude from sea level can affect the CO value CO SMO is shipped from the factory with barometric pressure compensation set at 760 mmHg sea level If the monitor is used in an area with a different normal barometric pressure the compensation should be changed to the new pressure value Normal day to day barometric pressure variations should not require adjustment of the monitor s barometric pressure setting Monitors with version 1 9 software do not support automatic barometric pressure compensation These monitors can be identified by an L in the serial number suffix Refer to the appropriate section below regarding the vari
134. picture of the CO waveform A Respiratory Rate Editor can be enabled to make the instrument more selective in its differentiation of waveforms caused by breathing and those introduced by artifact As a result when the editor is in use the monitor will adapt slowly to sudden changes in respiratory rate CO SMO User s Manual 3 Section 1 4 SpO Principles of Operation SpO Principles of Operation COSMO measures oxygen saturation and pulse rate with sensors that contain red and infrared light sources called LEDs Since oxygen saturated blood absorbs different amounts of light at each wavelength red and infrared as compared to unsaturated blood the amount of light absorbed by the blood in each pulse can be used to calculate oxygen saturation The light energy from red 660 nm and infrared 940 nm LEDs is beamed through a sample cell a pulsating vascular bed the patient s finger or toe for example The remaining light energy not absorbed by the sample cell reaches a light receptor called a photodiode on the opposing side of the sensor The data received at the photodiode is sent back to the monitor where it is split into its red and infrared components digitized processed by a microprocessor chip and finally displayed as a numerical value for oxygen saturation and a plethysmogram COSMO is calibrated to display functional saturation This differs from the fractional saturation value displayed by most co oximeters
135. protocol and budget requirements Please contact the Technical Support Group at Novametrix for additional information Additional Novametrix Technical Support Programs Focus Series Technical Training Seminars Test Equipment and Test Kits Service Contract Part Insurance Plans On Site Technical Support 24 hr telephone support Demand Services Flat rate parts exchange Flat rate return for repair Time and Material Full warranty discounted replacement sensors Vi COSMO Operator s Guide Rev 04 Rev 04 Contents LNIUSLItE U T 1 Acknowledgments eU estet IUe cereo eere tenete e ve eer eee es 1 Introductton eee 3 CO Principles of Operation eee cement pte RR Ce 3 SpO Principles of Operation sessssseseeeeeeeeeeeneeennen nennen nente tne entente ene nnne 4 Front Panel Controls and Connectors enne nennen nennen nennen 5 POWER Keys 3 eat eee rte etri de cet eb RE He Tete ie qd EET 6 AG Mains Operation eet eR OTHER EES 6 Battery Operation oer RE etre ENEE AER er 6 AUDIO Key eR ona hen tea aee tas 7 ALERT RESET Key oa ute ees 7 The Menu SOFTKEYS ege RIRs 8 EVENT Key 5 onset ee UT EA AE 8 CONTRAST EE 9 WAVEFORM Key eoe espere eie OE ERE Ere RUE ette Des 9 Red Alert Bar inso dirette petet onmi pU eene Fed re PE E EEOSE RET 9 CAPNOSTAT CO2 Sensor Input Connector essent 9 Sampling System Inlet Connector esesssssseesee
136. ps eicere tinere e tr ig e dne et beg eite ees 43 Y Sensor Application using Ear Clip eese nenne ener enne 45 YsSensor Quick Check EE 46 Single Patient Use SpO Sensors sss nnen nennen nennen 46 Intended Use ien oi UE odes 46 Instructions for Use ii ea eee ios oie anes d 47 Sensor Ppl Caton EE 49 Single Patient Use SpO gt Sensor Quick Check see 50 Monitoring SpO and Pulse Rate ccsseccseeeeeesseeeeeeeeeeeeeeseseeeeenseeeeseaeeenseeeesseeseeseeneesees 51 SpO RI UE EEN 51 Pulse Rate Display Averaging cocosii iicevis re serino nnne Eeee e E Ea aosi T EE e tret 51 Pulse Beep Volume rer rie tee PO ER PEE bebe EEE ESEO eterna 52 Signal Bat Sos Sank uc Lender eet tee era iie mc eH en 52 Plethysmogram Display 4 e ete tetti Pede tre pe tH ehe drei 52 Waveform AUtOSZe EEN pr e a rn I Fateh ue EET EUR Ee etos 52 Using the SIZE softkey o nri eR roD URP e 53 SpOs BEE 53 Display Held Timer 5 erento eere eese 53 Special Alert Delay ee tpe ib E ir re RR et 54 Bad Sign l Timer secondi e re HE GR EE 55 viii CO SMO User s Manual Rev 04 TABP Mode alte e ina amate edited 56 Making IABP Mode Available A 56 Turning IABP Mode On Off oo sess enne nrennne trenes 57 Using IABP MOUE etie e eee thea be te iip ee e hn rte et 57 j 59 OVerVI8W n ansa d iie aesti iuh tea te RE ter Ra EE A 59 t a E
137. r Set the rear panel power switch to the TT ON position Plug the other end of the line cord to a properly grounded three wire outlet NOTE Caution Ensure the AC ON indicator is illuminated when operation from AC mains is desired otherwise power for the monitor is drawn from the internal battery This can result in the monitor shutting itself off if the battery is allowed to drop to the low battery state See Battery Operation on page 6 Battery Operation COSMO uses battery power if the line cord is disconnected or the rear panel power switch is set to the O OFF position CO SMO can operate up to two hours from its internal battery While on battery power COSMO displays a battery icon to the right of the numerical Respiration display lili indicates a fully charged battery mms a half charge and 71 indicates less than 30 minutes of battery 6 CO SMO User s Manual Rev 04 Front Panel Controls and Connectors Introduction Rev 04 life remain Note The battery icon may appear fully charged for the first minute after switching to battery power wait one minute for the icon to truly reflect battery charge When approximately 15 minutes of battery life remains the front panel LOW BAT indicator starts to flash Reconnect the monitor to the AC Mains to recharge the battery The monitor can be operated from the AC Mains while the battery is being recharged The battery will be fully recharged in 12 1
138. r use If NOT CALIBRATED appears return the sensor to the ZERO cell and calibration is restarted If NOT CALIBRATED appears again or if CALIBRATION ERROR appears remove the sensor from use and contact the Novametrix Service Department Calibration Verification The user can at any time quickly and easily verify CO SSMO CAPNOSTAT calibration and should do so periodically Calibration verification is also warranted and easily achieved if clinical assessment of patient status by alternate means leads to questions of monitor accuracy To verify calibration Verify the COSMO is turned on and the CAPNOSTAT CO Sensor is plugged in Place the sensor onto the REF reference cell The reference cell is the one farthest from the face of the monitor The sensor cable should face away from the CO SMO CHECKING CALIBRATION is displayed If WAIT FOR SENSOR appears the sensor is not at operating temperature as might be the case if the monitor was just turned on or the sensor just plugged in CHECKING CALIBRATION will usually appear within about one minute CO SMO User s Manual 27 Section 4 Calibration 4 Within several seconds CALIBRATION VERIFIED should appear Remove the sensor from the cell The sensor is ready for use If NOT CALIBRATED appears remove the sensor from the Reference cell and place it on the Zero cell Calibration is automatically started and within 15 seconds later PLACE ON REF CELL should appear Place the sensor ont
139. ram Waveform Format eee 95 External DEVICES 99 NOVACOMT Interface eere eee tre ve prr e EHE 99 Mode 1 Real TIME r te etre ee 99 Mode 3 CO2 Waveform essere rennen nennen nennen nennen trennen 100 Mode 4 SpO2 Wavetform eese eene etit dene ente ot reiten 101 Mode 5 Dual Waveform eese eene nennen nennen trennen nentes 102 Mode 6 Trend Dump teer reir HERE petet 102 Mode d Date and Time sees enne enne entente nenne 104 Mode c Clear Trends si ccc og eere eoe ORE 105 Selecting NOVACOM Interface sesioen ie noie Terss eren eene en renes nennen nen 105 Selecting Analog Module Interface essere nennen nennen trennen 105 Connecting the Analog Module 106 Calibrating External Recorder e on nece tie etie ettet Esine tees 106 The NOVACARD Memory Module 107 Selecting NOVACARD Interface A 107 Connecting the NOVACARD Module 107 Selecting TeleCap Interface ieduesete eed umm ege etuer 107 Selecting TeleSat Interface 2 6 agente ettet rte ctu KEE te bet pen tbe EDES 108 Rear Panel RS232C ML LE 108 jLL 109 Cleaning and Sterilization acetone tee EENS NEE 109 Mom iate ee e Eee RE ere mi 109 SpOo Finger Sensor ise e Rd E eGR LS 109 SpO EE 109 SpO Y Strip Tapes and Foam Wraps sese 110 Ear Chip EE 110 Capnostat COs SENSOR EE EE tr
140. rends are displayed The Main or Base Menu is comprised of the following keys 60 GI bem JALET TRHD SCALE CAL MEHU e ALRT Set alert limits either manually or with Auto Alerts e TRND Trend page menus and displays e SCALE Capnogram sweep speed and vertical scale controls e CAL Airway Adapter calibration menus e MENU Access C02 OPTIONS O5 N50 compensation sampling pump on off and SYSTEM OPTIONS audible alert volume bright dim display averaging time menus EVENT Key Press the key to place an event marker into the monitor s trend memory Pressing the key while in the Main Menu will freeze the waveform for sixty seconds the message WAVEFORM FROZEN appears on the display To return to the real time display before the sixty second time out press the RUN softkey Pressing the EVENT softkey in menus other than the Main Menu will not freeze the waveform the event will however be recorded in trend memory Events are stored in trend memory for use in printouts and trend data examination The message EVENT MARKED is displayed each time an event is marked When the CO5SMO is configured for operation with a printer and the key is pressed PRINT WAVEFORM will be displayed for approximately 60 seconds Pressing the PRINT key during this time will cause a printout of the waveform The duration of this printout will be the 10 second interval immediately preceding the pressing of the key When the CO SMO is co
141. rometric pressure measuring circuit SATURATION SECTION SpO2 PROBE OFF PATIENT Sensor disconnected from patient improperly applied or placed on an area too translucent for proper sensor operation Reposition sensor SpO2 LOW SIGNAL The signal strength detected by the sensor is weak reposition sensor to a more perfused site SpO2 BAD SIGNAL Monitor not receiving valid signals from sensor May be caused by excessive motion cardiac arrhythmia or other situations leading to poor signal Check patient status reposition sensor CAN T I D SPO2 PROBE Sensor is placed on patient before being connected to the monitor always connect the sensor to the monitor first A non SuperBright sensor is connected Sensor is faulty Remove sensor from use and contact qualified service personnel CONNECT SpO2 PROBE Sensor is disconnected from the monitor Sensor is faulty Remove sensor from use and contact qualified service personnel Both sensor LEDs have failed or the cable connections are open or shorted SpO2 FAULTY PROBE Sensor faulty Remove sensor from use and contact qualified service personnel This error traps intermittent faults such as Probe Red LED or Infrared LED failures caused by frayed or broken wires in the sensor cable SPO2 HARDWARE ERROR 1 Monitor s circuitry is outside of calibration limits Contact factory for assistance COSMO User s Manual Rev 04 Rev 04
142. s Press RUN to return to the Main Menu Tabular Mode Text Printout Tabular Mode Printouts print the time SpO Pulse Rate ETCO Respiratory Rate and Inspired CO values once each 30 seconds The printed values reflect the monitor s display at the instant of printing To start a Tabular Mode Printout 1 Ensure the selected printer is connected and ready to print 2 Press the MENU key then the NEXT key SYSTEM OPTIONS appears 3 Press the PRNT key SELECT PRINT MODE appears 4 Press the TAB tabular key PRINTOUT STARTED is displayed and printing starts To stop a Tabular Mode Printout 1 Press the MENU key then the NEXT key SYSTEM OPTIONS appears 2 Press the PRNT key PRINT IN PROGRESS appears 3 Press STOP to stop the printout or press CONT to continue with the Tabular Mode Text Printout Capnogram or Plethysmogram Waveform Printout To start a capnogram or plethysmogram waveform printout 1 Ensure the selected printer is connected and ready to print 2 Press the EVENT key EVENT MARKED hh mm will appear followed by PRINT WAVEFORM The hh mm will be the time stamped by the monitor 3 Press the PRNT key or RUN key as desired Press PRNT to print the waveform If the capnogram or dual waveform display is selected a capnogram is printed if the plethysmogram display is selected a plethysmogram is printed The printer stops automatically when the printout is complete Press RUN to return to the Main Menu
143. s beside the Respiration display Resp Rate Lungs Icon Respiratory Interval Alert CO5SMO is equipped with a Respiratory Interval Alert The No Respiration interval alert time is selectable The time duration during which no respiration is detected before an alert condition is initiated can be from 10 seconds to 60 seconds in 5 second increments See Selecting the Respiratory Interval Alert Timer Duration on page 34 If no respiration is detected during the programmed time duration e The CO and Respiration displays are set to zero The A indicator and Red Alert Bar unless disabled by the user starts to flash e An audible alert sounds unless audio has been disabled e A NO RESP no respiration timer appears in the capnogram display area and shows the time in minutes and seconds 10 minute max since the last detected respiration No Resp Timer E HO RESP Bizi 6 Bo oceM GI bem ALET TRHD SCALE CAL MEHU If respiration resumes e CO and Respiration displays will reflect patient status e Audible and visible alerts will be reset at the third breath e The NO RESP timer will disappear at the third breath The No Respiration interval alert is selectable in software version 2 8 and newer Earlier versions are set at 20 seconds Monitors with version 2 8 software are identified by a CC in the serial number suffix Rev 04 CO SMO User s Manual 33 Section 5 Respiratory Rate If during
144. set the upper alert limit to 100 98 5 103 with max of 100 and the lower alert limit to 93 98 5 93 Pulse Rate Auto Alert Limits The pulse rate high auto alert limit is set at 25 more than and the low auto alert limit is 25 less than the pulse rate value that was displayed before AUTO was selected maximum 249 and minimum 30 For example if the pulse rate 72 when AUTO is pushed the system will set the upper alert limit to 90 72 25 72X1 25 90 and the lower alert to 54 72 25 72x0 75 54 Setting Alert Limits Manually The user can manually adjust alert limits CAUTION Care should be exercised to ensure clinically reasonable alert limit settings are selected Novametrix does not recommend the setting of limit values to such a wide span as to effectively render the alert limit feature useless Once the limit values are properly set the user should periodically confirm patient status by alternate means and not rely solely on alerts generated when a limit is violated Alert limit adjustment ranges are s ETCO High 100 5 Low 95 0 e Respiratory Rate High 150 5 Low 145 0 e Respiratory Rate alerts can be turned off by setting the High limit above 150 or the Low limit below 0 If the Respiratory Rate limits are off the limits display OFF and no Respiratory Rate limit alerts are generated e SpO2 High 100 55 Low 95 50 e Pulse Rate High 249 35 Low 244 30 e Pulse Rate alerts can be turned off by settin
145. sired SPO2 SETUP OPTIONS reappears ON allows continual automatic adjustment of the magnitude of the plethysmogram OFF allows the user to lock plethysmogram s vertical scaling making the waveform magnitude reflect relative signal strength Press RUN to return to the Main Menu Using the SIZE softkey With the plethysmogram displayed and Plethysmogram Autosize turned off a SIZE key appears in the Main Menu During the first thirty seconds after the SpO sensor is applied to the patient the monitor adjusts the vertical size of the plethysmogram to best fit the display area The monitor then locks the vertical scaling of the plethysmogram so that subsequent changes in the magnitude of the pulsatile signal cause the plethysmogram to grow smaller or larger and provide an indication of changes in pulsatile signal strength relative to the lock point The lock point is indicated on the Signal Bar by dots on either side of the bar Once locked stronger or weaker signals will still cause the Signal Bar to grow or shrink but the dots marking the lock point remain in place These lock points remain fixed until the user presses SIZE and a new lock point is determined If the magnitude of the patient s pulsatile signal strength changes to the point where the plethysmogram is too small or too large to be of practical value press the SIZE key The monitor will unlock the vertical scaling and Signal Bar lock point display
146. st time a particular sensor is connected to a particular monitor as is the case the first time you power up your COSMO and CAPNOSTAT CO Sensor Once calibrated CO SMO can be turned off and on and the CAPNOSTAT CO Sensor can be unplugged and reconnected without having to recalibrate However if a second CAPNOSTAT CO Sensor is connected in place of the original the new sensor must be calibrated and if at a later time the original sensor is reconnected it too will then have to be recalibrated To perform a CAPNOSTAT CO Sensor calibration Verify the CO SMO is turned on and the CAPNOSTAT CO Sensor is plugged in Place the CAPNOSTAT CO sensor onto the ZERO cell A TIME REMAINING counter is displayed The sensor cable should face away from the COSMO If WAIT FOR SENSOR appears the sensor is not at operating temperature as might be the case if the monitor was just turned on or the sensor was just plugged in The TIME REMAINING message indicates that the sensor is being calibrated and will usually appear within about one to two minutes The actual calibration will take typically less than 15 seconds After the timer counts down PLACE ON REF CELL appears Remove the sensor from the ZERO cell and place it on the REF reference cell The sensor cable should face away from the CO SMO CHECKING CALIBRATION is displayed Within several seconds CALIBRATION VERIFIED should appear Remove the sensor from the cell The sensor is ready fo
147. t fuses Separate collection Ensure that spent batteries are collected separately when disposed of Found on the E internal battery Refer to qualified service personnel when battery replacement is required Xy Equipotentiality Connection to monitor s chassis CO SMO User s Manual 5 Section 1 Front Panel Controls and Connectors POWER Keys To turn CO5SMO on press either the or key To turn the monitor off press both the and keys COSMO powers up as a combined ETCO SpO monitor If only the capnograph or pulse oximeter portion is going to be used the unused half can be disabled to avoid nuisance alerts and error messages With the monitor turned on press either POWER key to shut down that half of the monitor Press the key again turn that half back on To turn CO SMO off while only one parameter is active press the power key associated with the active parameter ETCO2 OFF Press key to turn off CO Q7 60 bem ALET TEHD A d Press key mmHa brm to turn off SpOs SrP z OFF ALET TRHD SCALE CAL MEHU AC Mains Operation COSMO uses AC Mains line cord power if available and automatically switches to battery operation if AC Mains power is removed or not present An illuminated AC ON w indicator means the CO2SMO is connected to AC Mains power and the internal battery is being charged To power CO SMO from AC Mains line cord power Plug the line cord into the rear panel AC input connecto
148. t the connectors are clean and dry with no signs of contamination or corrosion Do not use a broken or damaged sensor or one with wet contaminated or corroded connectors Perform a Quick Check to verify the integrity of the sensor See Y Sensor Quick Check on page 41 SpO gt Y Strip Tapes and Foam Wraps Treat Y Strip Tapes and foam wraps in accordance with hospital protocol for single patient use items Ear Clip Do not immerse the ear clip Clean the ear clip with a cloth dampened with 70 isopropyl alcohol After cleaning wipe the ear clip down thoroughly with a clean water dampened cloth to rinse CAPNOSTAT CO Sensor Clean the sensor surface with a damp cloth Ensure the sensor windows are clean and dry Do not immerse the CAPNOSTAT CO Sensor Do not attempt to sterilize the CAPNOSTAT CO Sensor Reusable Adult Airway Adapter The Adult Airway Adapter Cat No 7007 may be cleaned by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant or pasteurized or cold sterilized gluteraldehyde It should then be rinsed out with sterile water and dried The Adult Airway Adapter Cat No 7007 may be sterilized using steam autoclave or ETO ethylene oxide gas methods Be sure to use appropriate aeration times Before reusing the adapter ensure the windows are dry and residue free and that the adapter has not been damaged during handling or by the cleaning sterilization process Reusab
149. tage of the total time the parameter was within the category To the right of the bar graphs are numerical tabulations also showing how long the parameter was within that category Trend Data Compression Data is stored into trend memory every eight seconds COSMO can display any 12 hour 8 hour 2 hour or 30 minute portion of its 24 hour trend memory Since the size of the trend display is a fixed width the monitor must compress the trend data to fit onto the display the more data present the more it must be compressed to fit onto the display The COSMO trend display is approximately 200 pixels picture element wide Each horizontal pixel data point is equivalent to the following times 1 data point per 8 seconds in a 30 minute trend 1 data point per 32 seconds in a 2 hour trend 1 data point per 128 seconds approx 2 minutes in an 8 hour trend 1 data point per 192 seconds approx 3 minutes in an 12 hour trend The monitor determines the trend duration and compresses that amount of data to fit the screen older data to the left the most recent to the right Because of data compression data at any horizontal pixel may look like a vertical bar For COs the upper extent of the bar represents the maximum ETCO value and the bottom of the bar the maximum Inspired CO value stored during that particular compression period The ETCO value displayed above the graph represents the maximum ETCO value stored over the compression period
150. ter ener ener ene en nen nest entrer en nennen nennen enns 25 NonzIntubated Patients et ette RE rec REIR SEES LEM 25 Calibration 3 eR Ie SOR IS 27 Sensor Calibration EE 27 Calibration Verification eese eren nennen nennen nennen netter innen 27 Adapter Calibration iioii eU t edite redes cie e Db egeo pe edet 28 Monitoring CO and Respiratory Rate esee nennen nnns 29 Carbon Dioxide EE EE ae ee A ip Re de SR ee 29 End Tidal CO3 sds eo ee e Oxygen Compensation Nitrous Oxide Compensation ccc ce eseese eneee re ehen pee nennen nennen 30 Barometric Pressure Compensation esee eee enne 31 ET COs E EE 31 Inspired CO CO Display Units RES piratory Rate seess REENEN en EA ENEE Respiratory Interval Alert eese enne ener ener eene 33 Selecting the Respiratory Interval Alert Timer Duration eene 34 Respiratory Rate Editor peserta etess esine eee gre eu e pere re tts 34 WEIEN 35 Capnosrami S peed EE 35 Capnograim Scale sisri enontecendeesonhebeni e ouem edipi mer 36 Selecting the Instantaneous CO2 Mode sss eene 36 ek 37 OxySnap Connectors 55 npe piede eoe oit etate hte e or eie ri e dee rer 37 Finger Sensor oe ete EE wl Dist eU de e rebel 38 Finger Sensor Quick Check 2 ertet rrr epp retra Rs 38 KEE 39 Y Sensor Application using Wrap Style Tapes 0 sss 39 Non Adhesiv Foam Wrap tee tese ueterem inrer oett ee eb ee EE NeE SEE eee EES 41 Adhesive Foam Wra
151. ter together until they click 3 Connect the sampling tubing to the Sampling Inlet port located on the front of the monitor 4 Connect a Dehumidification Tubing Set to the Sampling Airway Adapter Use of the Nafion Dehumidification Tubing Set Cat No 8908 is optional Its use is recommended especially during high humidity or lengthy monitoring episodes 5 Connect a Nasal CO Sampling Cannula to the Dehumidification Tubing Set Or to the Sampling Airway Adapter if not using the dehumidification tubing Shown with CAPNOSTAT CO Sensor Cat No 7167 may also use Cat No 7067 Nasal CO Cannula Cat No 8781 8780 8906 or 8907 SE Sampling Airway Adapter P with tubing Cat No 5843 Dehumidification Tubing Cat No 8908 To Monitor Sampling Inlet Cat No Cannula Type 8781 Nasal CO Sampling Cannula Adult 8780 Nasal CO Sampling Cannula Pediatric 8906 Nasal CO Sampling and O Delivery Cannula Adult 8907 Nasal CO Sampling and O Delivery Cannula Pediatric 6 Ensure the sampling pump is turned on the pump icon is displayed To turn the sampling pump on or off Press the MENU softkey and CO2 OPTIONS appears Rev 04 CO SMO User s Manual 25 Section A Sampling Airway Adapter Press PUMP and SET SAMPLING PUMP appears Press ON to turn the sampling pump on or press OFF to turn the pump off 7 If necessary perform an adapter calibration Otherwise skip
152. terference e Data Validity The Pulse Oximeter should not be used as a substitute for an ECG monitor The oximeter s Pulse Rate display reflects the pulsatile flow found at the patient extremity connected to the sensor This rate can be affected by many factors and may occasionally be frozen e Do NOT attach an SpO sensor distal to a blood pressure cuff Valid data CANNOT be processed when the cuff is inflated Attach the sensor to the limb opposite to the site used for the blood pressure cuff e A NO RESPIRATION alert is not generated when the CAPNOSTAT CO Sensor is not connected to the monitor The COSMO has no protection against the ingress of water Cautions CAUTION Indicates a condition that may lead to equipment damage or malfunction e Do not operate COSMO when it is wet due to spills or condensation e Do not operate CO SMO if it appears to have been dropped or damaged e Never sterilize or immerse the monitor in liquids e Do not sterilize or immerse sensors except as directed in this manual e Tension should not be applied to the sensor cable e Overstretching the pulse oximeter finger sensor can damage the sensor and potentially affect pulse oximeter readings Do not stretch the finger sensor open beyond the limit for which it was designed Overstretching can be prevented avoid opening the sensor by any means other than squeezing the grips Do NOT force the sensor onto large objects such as t
153. the data at the cursor location The status line includes the following information e The date and time the data at the cursor was stored in trend memory The time is stored in 24 hour format e g 13 30 00 1 30 p m e Foran ETCO trend the ETCO E Inspired CO I and Respiratory Rate R values at the time the data was stored e For an SpO trend the SpO S and Pulse Rate P values at the time the data was stored e Ifa trend Event was marked at the time indicated by the cursor an E appears in the right corner of the status line This space is blank if no event was marked Move the cursor by pressing the or gt arrow keys to the desired time Press the EXPAND softkey Successive presses of the EXPAND key cause the 8 hour 2 hour and 30 minute trends to be displayed Press EXPAND again to return to the 12 hour trend display Use the arrow keys to fine tune the cursor to the desired location in the trend Press the RUN key to return to the Main Menu Dual Trend Displays When the TRND key is pushed the ETCO data is displayed if the Capnogram or dual waveform display is running or SpO data is displayed if the Plethysmogram was running CO SMO will display both ETCO and Respiratory Rate or SpO and Pulse Rate trend data simultaneously if this was chosen previously by selecting dual trend displays To select dual trend displays Press the TRND softkey Wait for the trend to be displayed Press the N
154. this column indicates that the audible alarms were silenced during this portion of the printout Column B shows marks where Events were added to trend memory Data Scales The ETCO and Respiratory Rate scales or Pulse Rate and SpO scales are printed and dotted lines within the data section correspond to the major divisions shown on the scale lines Alert Limit Settings Following the data ratio and just before the actual data are the alert limit settings Each scale has two triangle shaped markers that represent the upper and lower alert limit settings as shown on the monitor s display Dashed lines extend from these markers down into the data section of the printout If the alert limits were changed during the time the printed data was originally collected the new alert limits will be printed with a message indicating that the limits were changed Data Section The data is printed based on the compression ratio A time stamp is placed at regular intervals and appears as a horizontal line printed between the scales Histogram Data A histogram based on the printed portion of trend memory is printed after the graphical data for all trend printouts Total Elapsed Time Time trending was active the total time covered by the printout Non Monitoring Time For CO trends this is usually time spent with the CAPNOSTAT on the calibration cells For SpO trends this is time spent in SpO2 PROBE OFF PT or a similar non monitoring condition L
155. this step Adapter Calibration is necessary when the pump is first turned on in order to set the sampling system alert thresholds and to compensate for the unique optical characteristics of the sampling airway adapter After the first sampling adapter calibration subsequent patient setups using sampling adapters do not require adapter calibration so long as the pump is not turned off and similar cannula dryer tubing combinations are used Adapter Calibration should also be performed if the monitor displays CAL CO2 CANNULA To perform a Sampling Adapter Calibration e Press CAL and CO2 CANNULA ATTACHED appears e Verify the cannula and dryer tubing if used is attached to the adapter and the adapter tubing is attached to the monitor e Press CONT continue and PLACE ON ADPT IN RM AIR appears e Place the cannula away from all sources of CO including the patient s and your own exhaled breath and ventilator exhaust valves e Press START TIME REMAINING counts down and the Main Menu reappears The actual calibration will take typically less than 15 seconds NOTE If the monitor detects changing CO levels breaths during an adapter calibration BREATHS DETECTED is displayed followed by PLACE ON ADPT IN RM AIR To continue remove the source of COs wait 30 seconds and press START 8 If using a Nasal CO Sampling and O Delivery Cannula attach the O tubing to the administration device and set the device t
156. tion helps to avoid nuisance alarms while still alerting the user to a persistent condition An alert message is displayed as soon as a special alert occurs and if the duration of the special alert exceeds the Special Alert Delay setting the SpO and Pulse Rate displays will blank out and display the JL indicator starts to flash and the audible alarm will sound unless disabled by the user The Special Alert Delay also controls the blanking of the SpO and Pulse Rate displays during a NO SAT UPDATE event Refer to Display Held Timer To determine or alter the current setting of the Special Alert Delay 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears Press the NEXT key SPO2 SETUP OPTIONS appears Press the NEXT key SPO2 TIMERS appears eer Ja Press the SPEC special key SPECIAL ALERT DELAY appears 54 co sMO User s Manual Rev 04 SpO gt Timers Monitoring SpO and Pulse Rate The current setting flashes 5 Press 30s 45s 60s or 90s seconds as desired SPO2 TIMERS reappears 6 Press RUN to return to the Main Menu Bad Signal Timer The Bad Signal Timer feature provides audible unless disabled by the user and visible alerts in the event the monitor does not receive valid pulse and saturation data from the sensor i e a regular and rhythmic pulsatile signal for an extended period of time Typically conditions such as continuous excessive motion cardiac arrhythmia or other physiol
157. trend data as well as data that is output to external devices such as printers Unlike other monitor settings the clock calendar is not reset by the power up with Alert Reset key feature The clock calendar must be reset manually To view alter the current time and date setting 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears 2 Repeatedly press the NEXT key until MONITOR OPTIONS 2 appears Ee Press CLOCK and the clock calendar setup menu appears The current hour setting is flashing Each press of the SEL select key selects a new item to highlight flash Press T or J to increase or decrease the setting of the highlighted item When the time and date are correct press SET MONITOR OPTIONS 2 appears zs SON pe E Press RUN to return to the Main Menu Display Monitor Software Revision Level To check the revision level and date of CO SMO s system software 1 Press and hold the MENU key for 3 seconds CO2 SETUP OPTIONS appears Repeatedly press the NEXT key until MONITOR OPTIONS 1 appears Press the VER version softkey The software version number appears Press the NEXT key The date of the software version appears Press the NEXT key MONITOR OPTIONS 1 appears Qw pne RS Sr a Press RUN to return to the Main Menu 74 COSMO User s Manual Rev 04 Section 11 Menu Tree The menu flow diagrams of the CO SMO are listed in the following pages each menu is shown with its associated softkeys Re
158. uperBright series These sensors are used with the DB 9 extension cable Neonatal pediatric sensor Pediatric adult sensor WARNING Use the Single Patient Use sensor and DB9 extension cable only with Novametrix SuperBright compatible pulse oximeters Use with any other device may result in equipment damage or patient injury 46 CO SMO User s Manual Rev 04 Single Patient Use SpO Sensors SpO2 Sensors CAUTION These SpO s sites on the same patient but should not be used on multiple patients Do not attempt to clean or disinfect the sensor as system performance will be compromised ensors are intended for single patient use The sensors can be reapplied to various NOTE The Single Patient Use sensor should be discarded if sensor integrity becomes questionable Instructions for Use 1 Connect the DB 9 extension cable to the rear panel conector on the CO SMO Hev 04 SpO2 Input Connector ve D I oau CH WALLINGFORD CONNECTICUT U S A RS232C NOVAMETRIX ACCESSORIES A CAUTION FEDERAL N e LAW RESTRICTS THIS DEVICE TO SALE DISTRIBUTION OR USE BY OR ON THE ORDER OF A LICENSED MEDICAL PRACTITIONER REPLACE FUSE AS MARKED 0 5A S B 2 100 120V T250mA 2 200 240V CAUTION EQUIPMENT MUST BE GROUNDED AT ALL TIMES TO AVOID DANGEROUS ELECTRICAL SHICK HAZARD PATENTS 4 859 858 4 859 859 4 914 720 4 958 ay AG 146 092 5 15
159. ute Silence or stop Two Minute Silence or Audio Off Press and hold three seconds to start Audio Off 7 O Audio Off Flashes when key is pressed for three seconds Indicates audible alerts have been disabled 8 Press to turn off alert indicators Alerts will reactivate if still valid 9 A Alert Flashes red as soon as an alert occurs 10 Softkeys 5 Perform the action annotated in the Message Center above each key 11 bel Press to mark an event in trend memory When pressed while in the Main Menu the waveform is frozen for sixty seconds Pressing the RUN softkey will return to real time instantly Rev 04 12 Contrast Press to adjust display contrast for optimum viewing 13 Press to switch between capnogram plethysmogram or dual waveform displays 14 CO Input Connector Plug the CAPNOSTAT CO Sensor in here 15 Sampling System Inlet Connector The Sampling Airway Adapter tubing plugs in here 16 Red Alert Bar Flashes red when alert is latched Symbols Patient isolation Identifies connection as type BF A Attention Consult manual for detailed information Indicates heavy metal content specifically lead Found on the internal battery and monitor enclosure Refer to qualified service personnel when battery replacement is required Recyclable item Found on the internal battery Refer 5 to qualified service personnel when battery replacement is required Mains fuse rating for replacemen
160. utes of battery life remain Note The battery icon may appear fully charged for the first minute after switching to battery power wait one minute for the icon to truly reflect battery charge When approximately 15 minutes of battery life remain the front panel LOW BAT indicator starts to flash Reconnect the monitor to the AC Mains to recharge the battery The monitor can be operated from the AC Mains while the battery is being recharged The battery will be fully recharged in 12 15 hours If the monitor continues operating on battery power while in the low battery state Bf indicator flashing the message BATTERY VERY LOW PLUG IN AC POWER is displayed If the monitor is allowed to continue operation while in the very low battery state the monitor will alert then shut itself off to prevent damage to the battery and monitor This alert cannot be silenced by pressing the key The monitor must be connected to AC Mains power to silence the alert condition and recharge the battery See AC Mains Operation on page 6 16 co swO User s Manual Rev 04 Section 4 CAPNOSTAT CO Sensor This section explains how to select an airway adapter based on the patient to be monitored connect the airway adapter to the CAPNOSTAT CO Sensor and to the patient s airway circuit and how and when to calibrate the airway adapter and sensor Airway Adapter Selection Select an airway adapter based on the patient and monitoring situation e Adult Airwa
161. v 04 CO SMO User s Manual 75 ALRT TREND SCALE CAL MENU This is the MAIN Menu D See page 2 for TREND menu tree e SCALE will be displayed if Capnogram or dual waveform is SET ALERT LIMITS displayed CO2 OPTIONS SYSTEM OPTIONS RUN SEL T SIZE will be displayed if RUN 02 N20 PUMP NEXT RUN AUDIO LITE AVG Y Plethysmogram waveform is C MAN 5 C Up Down gt displayed and Pleth Autosize is on Otherwise key is blank C Select Limit to Adjust C Set Auto Alerts gt SET SAMPLING PUMP ON OFF CARD will appear if NOVACARD 2 i i interface is selected On Off PRNT will appear if a printer IABP will appear if IABP Pog i e GDTOUPENENUON interface is selected mode is selected in SpO2 Setup Options gt ON OFF Y PP i i AVERAGING SELECTIONS eren Hl RUN NoResp CO2 SPO2 IABP Plethysmogram Wave Capnogram or dual waveform OKt C ot ji o No p CANNOT CALIBRATE gt Cui Displayed C MAN 5 SIE Cal on Adapt THIS SENSOR O2 COMPENSATION gt 60 ON OFF Ce V4 On Off SELECT IABP MODE MAIN Ee ON OFF Ea RESIZING PLETH PLACE ON ADAPT IN ROOM AIR START CANCEL i MAIN Select t s SpO2 AVERAGING 2s 8s No WAIT FOR SENSOR CANCEL Select Pog MAI
162. ve material is expected to be returned to Novametrix within 10 days of being provided in order to avoid additional charges Exchanged material should be returned promptly and directly to Novametrix using the return paperwork and shipping label s provided Transferring return materials to local sales or dealer representatives does not absolve return responsibility Novametrix manufactures equipment that is generally user serviceable and can usually be repaired with the replacement of a plug in electro mechanical assembly by the clinical end user When repair parts are provided the recipient can call into Novametrix for on line replacement assistance and repair assurance In the event a replacement part requires increased technical capability Technical Support may request Biomedical assistance provide on site technical support or complete replacement equipment If the customer requires the return of their original product the exchange material will be considered loaner material and exchanged again after the customer equipment is repaired Novametrix promotes customer participation in warranty repairs should they become necessary This program allows for customer training and a smooth transition into self maintenance after warranty which can provide substantial cost savings on repairs throughout the product s life The Novametrix Technical Support Department can provide technical product support at a level appropriate to most customers
163. ween the CO SMO s RS232 connector and the printer s upper rear panel connector If using the 6887 00 cable connect the printer s external power supply to its rear panel and the AC supply If using the 5861 00 cable connect the cable s power supply connector to the printer power input connector Seiko Model 411 DPU Rear Panel Interface Cable top connector Printer power input If using 6887 00 interface cable use printer s external supply If using 5861 00 interface cable use cable s input connector 4 Turn the printer ON Refer to the Seiko Model DPU 411 documentation for specific printer operation and maintenance instructions 88 co sMO User s Manual Rev 04 Print Formats Using a Printer Connecting the Hewlett Packard ThinkJet Printer To connect the Hewlett Packard ThinkJet Printer to CO SMO 1 The ThinkJet must be a Hewlett Packard Model 2225D RS232 serial interface 2 Set the dip switches on the rear panel of the ThinkJet as indicated below AAYYAAYY AYYYY B a 12345678 12345 H EL Mode switches 1 2 5 6 up on and 3 4 7 8 down off RS 232C switches 1 up on and 2 3 4 5 down off 3 Connect the interface cable Catalog No 5331 00 to the monitor s RS232 connector and to the printer s serial input connector Markings at each end of the cable help orient it properly 4 Connect the printer s power cord and turn the printer on
164. with solutions such as a 70 isopropyl alcohol 2 gluteraldehyde or 1046 bleach solution Then wipe down with a water dampened clean cloth to rinse Dry before use e Make certain that the finger sensor windows are clean and dry before reuse e Do not immerse the finger sensor Do not attempt to sterilize the finger sensor e After cleaning the finger sensor verify that the sensor is physically intact with no broken or frayed wires or damaged parts Make certain that the connectors are clean and dry with no signs of contamination or corrosion Do not use a broken or damaged sensor or one with wet contaminated or corroded connectors e Perform a Quick Check to verify the integrity of the sensor See Finger Sensor Quick Check on page 35 SpO Y Sensor Do not immerse connector on the Y Sensor Rev 04 CO SMO User s Manual 109 Section 15 Cleaning and Sterilization The Y Sensor may be immersed up to but not including the connector in a 2 gluteraldehyde solution or 10 bleach solution Refer to manufacturer s instructions and standard hospital protocols to determine recommended times for disinfection and sterilization Rinse thoroughly with water and dry before use do not rinse the connector Do not attempt to sterilize Y Sensor except as stated above After cleaning or sterilizing the Y Sensor verify that the sensor is physically intact with no broken or frayed wires or damaged parts Make certain tha
165. without printing Zoom Trend Printout To create a Zoom Trend Printout 1 Ensure the selected printer is connected and ready to print 2 Press the MENU key then the NEXT key SYSTEM OPTIONS appears 3 Press the PRNT key SELECT PRINT MODE appears 4 Press the TRND key PRINT TREND appears 90 co sMO User s Manual Rev 04 Print Formats Using a Printer 5 Press PART The START time menu appears 6 Press T or J to select the point time in trend memory to start the printout 7 Press the SET key The STOP time menu appears Or press RESET to reset the start time to the beginning of trend memory 8 Press T or J to select the point time in trend memory to stop the printout 9 Press PRINT Or press RESET to set the stop time to the programmed start time 10 PRINTOUT STARTED is displayed and printing starts If the capnogram display is selected ETCO and Respiratory Rate data is printed if the plethysmogram display is selected SpO and Pulse Rate data is printed The printer stops automatically when the printout is complete If PRNT is pressed again before the printout finishes PRINT IN PROGRESS appears Press STOP to terminate printing or press CONT continue to resume printing Compressed Trend Printout To create a Compressed Trend Printout 1 Ensure the selected printer is connected and ready to print 2 Press the MENU key then the NEXT key SYSTEM OPTIONS appears 3 Press the PRNT key SEL
166. y Adapter Catalog No 7007 For patients with Endotracheal Tube diameters greater than 4 0 mm e Single Patient Use Adult Airway Adapter Catalog No 6063 For single patient use with Endotracheal Tube diameters greater than 4 0 mm e Single Patient Use Adult Airway Adapter with Mouthpiece Catalog No 6421 For single patient use for spot checking CO on non intubated adult or pediatric patients e Neonatal Airway Adapter Catalog No 7053 For patients with Endotracheal Tube diameters less than or equal to 4 0 mm e Single Patient Use Neonatal Airway Adapter Cat No 6312 For monitoring intubated patients with an ET tube size of 4 0 or smaller e Sampling Airway Adapter with tubing Catalog No 5843 For non intubated patients when used in conjunction with a nasal sampling cannula Adult Airway Adapter The Adult Airway Adapter Catalog No 7007 should be used when monitoring patients with Endotracheal Tube diameters greater than 4 0 mm Alternatively the Single Patient Use Adult Airway Adapter Catalog No 6063 may be used See Single Patient Use Adult Airway Adapter on page 19 1 Verify the windows are clean and dry Clean or replace the adapter if necessary 2 Snap the airway adapter into the CAPNOSTAT CO Sensor Align the arrow on the bottom of the airway adapter with the arrow on the bottom of the CAPNOSTAT CO Sensor Press the sensor and airway adapter together until they click 3 Ifnecessary perform an adapter

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