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Achieva® Ventilators

1. 4 2 Accessory checklist muii RR 4 3 POWBES ete 4 4 A cas 4 4 External Battery 24 Volt DC ii AA et a b 4 5 External Battery 12 Volt DC tri 4 6 Battery Performance eo weds di idad 4 7 Testing the Baten Sus eum tue Miro ive 4 8 External battery Precautions ose arie reia 4 9 Internal Battery 24 Volt DE 4 9 Attaching the parienta ar is 4 12 Attaching oXygen uice sins 4 15 Short term humidification sss eene 4 16 Extended Use ER 4 17 Connecting to a nurse call 4 19 November 2003 i Achieva Ventilator Clinician s Manual Operating the controls ao ERR Oe ERE NR UR MEER DEN IR INDE 4 21 A LP 4 23 Setting the low pressure 4 26 Operation A AA 5 1 Starting the ventilator ee rere re rx Re Rea Rm ea FERRO CERE EUR Aa EH ER es 5 1 Stopping the ventilator ei ass 5 2 Sensitivity and adjustment iii ii di 5 3 Display of settings 00 da cette ede 5 3 Changing mode Sis iria 5 3 Flow tigger dose Std uad R RESER T 5 4 Pressure MIE IST ls 5 5 Altit de setting aia 5 6 Assist Control mode volume breaths ooccoocccocnccccnnnccnnconnncnnanonanonnnons 5 7 Limiting inspiratory flow Flow
2. 5 8 EXPIFOTONY sensitivity osse cae tice edite LG ee ge o E bats AAN 5 9 Assist Control mode 5 10 SIMV mode with pressure SUPpPOT ccccoocccccccnncccccnnoncncnnnnnccnncnnononncnnnccnnnnnns 5 11 SIMY miode With CPAP c serio reet kd aec at dre tes ia Mas 5 12 Spontaneous mode with pressure support Flow acceleration 5 13 Spontaneous mode with CPAP Achieva PS and Achieva PSO2 5 15 Ventilation modes and e eroe ierra om CAES 5 16 Monthly safety check esce terno A AA AS 5 17 Verifying Alarm Functions coccion tia nine Gase eov epo d eroe o vu 5 18 Menu selectioris i eaa nu nea eaa suae E ERR ERO aea gu suae 5 22 Users toos 5 22 Ventilating oU ES a RO 5 22 Pressure HIGUERA aia 5 23 oti oett ri cnra dete abeo edt hh is ina o dio MEO 5 23 What the patient and caregiver must know ooooccccoocccccccnncccncnononccnnnnnnoos 5 25 Alarms and alertS ooo 6 0 0 0 06 0 6 6 1 Alarm SOIC eos rie baa o ke emu e Rubri tbe eibi p 6 3 Latching and non latching ooccccoooccccnccnoncnnnnnoccnnnononccnnnnnarcnnnonacinnnnnns 6 4 Presil rice orta s A O dla 6 5 Resetting alar Tis oes ecc A cca pM eu dee 6 5 Alarm conditions
3. 6 6 Troubleshooting error dl da 7 1 Troubleshooting Chat iaa 7 1 Maintenance 000000000000000000000000000000000000000000000000000000 8 1 Cleaning and steriliza ica 8 1 Ventilator surface a ossi ami iaa 8 2 ii November 2003 Achieva Ventilator Clinician s Manual Ala O tete nd tabs eec al OS 8 2 Changirig the Usen ato 8 4 Periodic maintenance occoccccnccnccnccncnocnocnnoncnnccncononccnccnncncnnonocnncnncnccncnnnos 8 6 Ventilator data 0c0000000000000000000000000000000000000000000000000 A 1 Printing reports from the A 1 Local data Trae dd A 3 Download proced re ai ai vun A 4 Repiote datdTFaSIeE aep dd s A 6 A aues uae what swsR etasesva E svas sus2 vas ese ae B 1 ResoUKBS Lio vv EVO A VARASYERERSEER TS IRE ERO VR nl Bibliography EDD C 1 eter tt teat ete en utate NU Ite E Putat C 1 Theory of operation 2 2 2o vus yb us e a e uh ye ER PER e Eh eT EPA D 1 Preutmalic censui eei co IR REO AI En AR tetas D 1 Breaths and ventilation ModeS cccececececececcecceccecececececscecectcscecucesess D 4 Specifications cria al Service Ni E a Service information AE te b d tie F 1 o eo secu eres Qa ER e TEE So Ex CoD ETEA C ERRES EN E Pedes ux Sm aS F 2 November 2003 iii Achieva Ventilator Clinician s Manual November 2003 Achieva
4. November 2003 7 3 Troubleshooting Achieva Ventilator Clinician s Manual Conditions Display Message Probable Cause Solution Three pulse audible tone with flashing light High Pressure Pt Alarm High Pressure Alarm Attend to patient Water in the tubing Remove water from tubing Crimped tubing Uncrimp tubing Coughing or other high flow expiratory efforts Treat patient s cough The alarm is appropriate for these condi tions Patient inspiratory resistance or compliance changes Have physician determine new ventilator settings Airway obstruction Check for trach obstruction or for a condition in which the patient requires suctioning Malfundion in the exhalation manifold Replace the exhalation manifold Setting Error Alarm Three pulse audible tone with flashing light High Pres lt Low Pres OR Volume error Attend to patient OR Breath Rate error Attend to patient OR Insp Time error Attend to patient OR Invalid E ratio Check settings Inappropriate setting or settings beyond the capabilities of the machine Readjust settings to the doctor s prescription Setting Error Alarm Three pulse audible tone with flashing light Ventilator hardware error Refer to manual OR Equipment error Refer to man val Hardware or equipment malfunc tion Press Alarm Silence Reset oos I
5. Power Entry Module dual fuse power entry module Provides connections for hot neutral and grounded conductors The receptacle incorporates fuses in the hot and neutral lines Inlet Filter Intake for patient air Screw off cap for filter change 98 efficient at 0 3 microns Patient Pressure Port Port for connection to the proximal pressure line of the patient circuit 3 16 1 D tube Remote Alarm Connector Connector for remote alarm Nurse Call Connector Connector for Nurse Call Station Patient Air 22mm 0 D 15 mm I D ISO Fitting Exhalation Valve Port Port for connection to the exhalation valve of the patient circuit 1 8 1 D tube November 2003 Appendix E Achieva Ventilator Clinician s Manual Sensors Primary Pressure Purpose Measures the proximal pressure for use in pressure control and pressure monitoring Location Proximal Type Souge pressure sensor Range 20 hPa to 120 hPa compensated Temperature Range 18 C to 63 C Accuracy 25hPo Secondary Pressure Purpose Provides backup pressure measurement for safety reasons Location Type Gouge pressure sensor Range 105 compensated Temperature Range 0 C to 55 C Accuracy 8hPo Oxygen Flow Purpose Measures the amount of oxygen entering the piston chamber during piston retraction Location Inlet to piston chamber Type Moss fl
6. OFF flow acceleration B Press START ENTER to accept the setting November 2003 Achieva Ventilator Clinician s Manual Operation Expiratory sensitivity November 2003 The expiratory sensitivity level is a percentage of peak flow at which a pressure supported breath will be terminated The expiratory sensitivity level has settings of 15 to 55 in 10 increments To set the expiratory sensitivity 1 Press che MENU ESC key 2 Press the up or down arrow keys until the display shows the mes sage Press ENTER to set Expiratory Sensitivity Press che ENTER key 4 Use the up or down arrow keys to change the expiratory sensitivity level in 1096 increments B Press ENTER to accept the setting Operation Achieva Ventilator Clinician s Manual Assist Control mode pressure controlled Warning 5 10 For patients with respiratory failure conditions ventilated in the pressure controlled or pressure supported modes the physician must determine at what level the patient may require an alternate means of monitoring effective ventilation To operate the ventilator in Assist Control mode pressure controlled 1 2 3 6 7 8 11 12 13 Press MENU ESC to enter the ventilator s menu system Set alarm latching see Latching and non latching on page 6 5 or pressure trigger level see Pressure trigger on page 5 5 and or operating altitude see Altitude setting on page 5 6 from the menu
7. 3 15 A A ACTION RETARD E The paragraphs warn of a fire hazard if you use replacement fuses that are not the same type and rating as the original fuses 3 14 November 2003 Achieva Ventilator Clinician s Manual Accessories Caution November 2003 Description The instructions for the proper use of accessories will vary depending on the manufacturer Follow the directions given to you by the manufacturer The use of accessory equipment not complying with the equivalent safety requirements of the equipment may lead to a reduced level of safety of the resulting system Consideration relating to the choice shall include evidence that the safety certification of the accessory has been performed in accordance to the appropriate IEC 601 1 and or TEC 601 1 1 harmonized national standard Use only Puritan Bennett approved accessories with the ventilator The use of other accessories may damage the unit and endanger the patient Accessories you may need include e Patient circuit e Exhalation valve e Air inlet filter e Bacteria filter e Humidifier system e Printer e Modem e External battery e Remote alarm e Achieva Report Generator Refer to the Achieva Approved Accessories Sheet that was shipped with your ventilator for more information 3 15 Description Achieva Ventilator Clinician s Manual 3 16 November 2003 Achieva Ventilator Clinician s Manual Set up Chapter 4 Set up This chapter provides
8. Achieva Ventilator Clinician s Manual Miscellaneous Maintenance Preventative maintenance must be preformed by qualified personnel every 6000 operating hours or recertification every twelve 12 months whichever occurs first Dimensions 27 3 X 33 8 X 39 6 cm 10 75 X 13 30 X 15 00 Weight Less than 32165 Resistance Factor Maximum of 4 5 hPa 60 LPM Compliance Factor 1 25 ml hPa for A C breaths 2 50 ml hPa for Pressure Support breaths Emergency Pressure Relief 90 10 hPa Response time 75 milliseconds under the following conditions Resistance 5 hPa l sec Compliance 50 ml hPa Breath Rate 20 BPM Volume 1500 ml Pressure support 10 hPa PEEP 5 hPa Response time varies inversely with the displayed flow rate and directly with the selected trigger level 2 0 LPM to 180 LPM Achieva ventilators are intended to operate within their specifications if they are properly maintained and the service schedule is followed Achieva ventilators are protected against electrostatic discharge of up to eight kilovolts 8 kV Electrostatic discharge greater than eight kilovolts may damage the ventilator Standard compliance The ventilator complies with the following international agency standards IEC 601 1 Medical Electrical Equipment 1988 Part 1 General Requirements for Safety IEC 601 1 2 Medical Electrical Equipment Part 1 General Requirements for Safety Part 2
9. Display screen WARNING Volume error Attend to patient Cause During a volume breath the ventilator did not deliver the set volume 12 Latching Status Non Latching Volume Error Alert Visual Indicator The Setting Error light will flash Audible Alarm Tone No audible alarm tone Display screen WARNING Volume error Attend to patient Cause With a pressure support breath the last two breaths did not stop within three seconds or For a pressure control breath or a pressure support breath the piston reached the end of travel on the last two breaths Latching Status Non Latching Pressure Differential Alarm Visual Indicator The Setting Error light will flash 6 10 November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Audible Alarm Tone Three pulses Display screen Pressure Differential Error Refer to manual Cause The pressure levels detected by two independent sensors differ by more than 15 cmH O Latching Status Non Latching November 2003 6 11 Alarms and alerts Achieva Ventilator Clinician s Manual Rate Error Alarm Visual Indicator sua e The Setting Error light will flash Audible Alarm Tone Three pulses Display screen WARNING Breath rate error Attend to patient Cause In Assist Control Mode breaths are delivered slower than the set breath rate or Tf the
10. Reposition the left side cover into place Secure the left side rail and the left side cover using a 1 8 hex driver and the two screws removed in step two Connect the nurse call system that will be used to the nurse call jack on the back of the ventilator and test for proper operation The nurse call system should be alerted during an alarm condition or when the ventilator is set to Standby November 2003 Achieva Ventilator Clinician s Manual Ventilator controls Alphanumeric display Ventilator controls Set up q 1 Menu Esc _ p CL No SIMV 1000 15 20 20 10 60 1 5 1 1 7 60 Ventilation mode and parameter controls Gel i City J It After beginning a ventilating mode the display panel shows the set values for ten seconds and then displays the actual values for each parameter The set value also appears for ten seconds after the value of a setting is changed Certain parameters such as the low pressure and high pressure alarm settings do not have an actual value For these dashes are displayed instead To set the ventilator s parameters displayed 2 displayed setting will begin to flash 3 4 If a setting is not displayed Some parameter selections Press the Start Enter 4 switch The current settings will be Press the switch for the parame
11. as needed From standby press Start Enter 4 to display the parame ters Set MODE to A C Set pressure support to the level prescribed greater than 0 Vol ume will not be displayed Set inspiratory sensitivity to an appropriate level Set the breath rate Set inspiratory time for the period the ventilator must maintain the pressure Set PEEP as required Set the low pressure and high pressure alarm levels See Setting the low pressure alarm on page 4 27 If required set F O available only on Achieva PSO Set Flow Acceleration to ON or OFE Press Ventilate am to begin air delivery November 2003 Achieva Ventilator Clinician s Manual Operation SIMV mode with pressure support Warning For patients with respiratory failure conditions ventilated in the pressure controlled or pressure supported modes the physician must determine at what level the patient may require an alternate means of monitoring effective ventilation To operate the ventilator in SIMV mode with pressure support Achieva PS and PSO only 1 Press MENU ESC to enter the ventilator s menu system Set alarm latching see Latching and non latching on page 6 5 pressure trigger level see Pressure trigger on page 5 5 and or operating altitude see Altitude setting on page 5 6 from the menu as needed From standby press Start Enter 4 to display the parame ters 4 5 MODE to SIMV B Set the prescribe
12. breaths The ventilator can also be set to trigger on both flow and pressure Flow triggering is always active Pressure triggering may result in improved response to patient demand If the ventilator is set to trigger on both flow and pressure it will respond to the threshold that is reached first When using PEEP consider setting the Pressure Trigger along with the sensitivity setting Flow Trigger See Pressure trigger on page 5 5 Display of settings Achieva ventilators display the set values for all parameters when not ventilating In a ventilating mode the ventilator displays the set values for ten seconds and then displays the actual values The set value also appears for ten seconds after the value of a setting is changed or the Start Enter key is pressed The set values and the actual values are never displayed at the same time Certain parameters e g low pressure and high pressure alarm settings do not have an actual value and dashes are displayed instead Changing modes When beginning ventilation in any particular mode the settings in effect the last time that mode was used are saved Before starting ventilation again or when switching to a different mode of ventilation check the values for all parameters November 2003 5 3 Operation Flow trigger Achieva Ventilator Clinician s Manual Use the sensitivity parameter to set the amount of flow the patient must generate before the ventilator will deliver a pat
13. equipment may be a source of infection Clean equipment and proper use of bacteria filters are essential to reduce the chance of infection For patients with respiratory failure conditions ventilated in pressure controlled or pressure supported modes the physician must determine at what level the patient may require an alternative means of monitoring effective ventilation November 2003 Achieva Ventilator Clinician s Manual Set up Attaching oxygen Warning November 2003 Connect an external oxygen source to the oxygen input connector on the back of the ventilator available only on Achieva PSO The connector is a DISS 1240 fitting Input pressure range is 138 552 kPa 20 80 PSIG NIST adapter kits are available from Puritan Bennett To start the oxygen blender the 0 setting must be above 21 The FjO5 0 level should be set according to the prescription The O Fail alarm will sound if the ventilator does not detect a flow source Supply pressures of less than 355 kPa 45 PSIG may result in reduced oxygen performance at some settings Optimum performance is achieved at 443 kPa 65 PSIG oxygen supply pressure It may take several minutes for the oxygen concentration to stabilize An oxygen supply capable of delivering a minimum of 80 SLPM Standard Liters per Minute is required to realize the full capacity of the blender The capacity of the oxygen blender is a function of tidal volume and inspira
14. is unable to deliver gases at the selected parameters Low Internal Battery Power Visual Indicator Low Power 4 light will flash Audible Alarm Tone Single beep every five minutes Display screen WARNING Low Internal Battery Power 6 16 November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Cause The ventilator is powered from the internal battery and can provide approximately 45 minutes of operation with the current settings Latching Status Non Latching Extremely Low Internal Battery Power Visual Indicator Low Power 4 light will flash Audible Alarm Tone Three pulses This tone can be silenced for five minutes by pressing the Alarm Silence Reset uj 60 s Switch Display screen WARNING Extremely Low Internal Battery Power Cause The ventilator is powered from the internal battery and can provide approximately 10 minutes of operation with the current settings Latching Status Non Latching Response to Low Internal Battery Power or Extremely Low Internal Battery Power alarms Connect the ventilator to a functioning AC electrical outlet or charged external battery The ventilator will continue operation and the internal battery will begin to charge November 2003 6 17 Alarms and alerts Achieva Ventilator Clinician s Manual Battery Charge Depleted Visual Indicator Low Power 4 lig
15. pressing the Start Enter switch will activate the display Start Enter 4 1 switch is also used to accept the currently flashing parameter as the new setting The MODE section of the display screen shows the current ventilation mode setting Pressing the MODE switch causes the current mode on the display to flash and allows the ventilation mode to be changed Volume Mp The Volume V section of the display screen shows the set or actual volume of air that is to be delivered to the patient s lungs during vol ume breaths Pressing the Volume Mp switch causes the current set value of the volume setting to flash and allows it to be changed Inspiratory Time T The Inspiratory Time T section of the display screen shows the length of time it takes the ventilator to deliver the volume and pres sure control breaths to the patient Pressing the Inspiratory Time T switch causes the current set value of inspiratory time to flash and allows it to be changed 3 6 November 2003 Achieva Ventilator Clinician s Manual Note November 2003 Description Flow V The Flow section of the display shows the average air flow deliv ered to the patient This calculated value is given in liters minute Sensitivity SENS The Sensitivity SENS section of the display screen shows the amount of flow generated by the patient that will trigger an assisted breath Pressing the Sensitivity SENS switch c
16. Assist Control mode e Pressure controlled in Assist Control mode e Mandatory volume breaths in SIMV mode e Pressure supported breaths in SIMV or Spontaneous modes e CPAP in SIMV or Spontaneous modes Volume In Assist Control mode with Pressure set to 0 each delivered breath will be of the selected Volume delivered over the selected Inspiratory Time breaths in Inspiration is triggered by patient generated flow or pressure drop for Assist assisted breaths or by the ventilator for controlled breaths Breath Rate is the controlling parameter For both controlled and assisted breaths the Control inspiration is limited by the volume and is cycled by volume and time mode See the waveforms on the following page D 4 November 2003 Achieva Ventilator Clinician s Manual Appendix D Start of inspiration End of inspiration y V Y i Time November 2003 D 5 Appendix D D 6 Achieva Ventilator Clinician s Manual Assist Control mode guarantees a maximum period between breaths as determined by the Breath Rate setting In the waveform below the ventilator delivers a controlled machine breath and calculates the time before another controlled breath must be delivered The ventilator delivers a second controlled breath at the conclusion of that machine calculated breath time for simplicity we will use the term period for machine calcul
17. Collateral Standard Electromagnetic Compatibility Requirements and Tests CAN CSA C22 2 No 601 1 M90 Medical Electrical Equipment Part 1 General Requirements for Safety UL2601 1 Medical Electrical Equipment Part I General Requirements for Safety 1994 Classified as Class 1 and internally powered Type BF drip proof not suitable for use in the presence of flammable anesthetics continuous operation November 2003 Achieva Ventilator Clinician s Manual Appendix F Appendix F Service This appendix provides service information and the limited warranty Service information November 2003 Achieva ventilators are warranted against defects in workmanship and materials The full text of the warranty provides the details Do not make any service repairs on this equipment during the stated warranty period Any unauthorized work immediately voids the warranty If you need information or assistance or if the information in this manual is insufficient contact Puritan Bennett Puritan Bennett does not recognize the owner of a ventilator as an authorized service representative Puritan Bennett will not be liable for any repairs attempted by the owner Any such attempted repairs other than specified non warranty repairs void the warranty Parts and labor costs incurred by the owner will not be reimbursed by Puritan Bennett Puritan Bennett will make available on request diagrams component parts lists descriptions calibrati
18. Fifteen Minutes Ventilator is ventilating and serious fault is detected Three Second Tone Ventilator is not ventilating and a serious fault is detected Alarm Volume 85 db or 70 db at distance of 1 meter November 2003 Achieva Ventilator Clinician s Manual Appendix E Controls 1 Silences audible alarms during an alarm condition 2 Silences an alarm before a known alarm Alarm Silence Reset 60 s condition occurs 3 Used to reset an alarm after the alarm condition has been corrected 4 Indicator and audible alarm tests 2 5 1 When the test battery switch is pressed the Patient Pressure Meter shows the charge level of the Test Battery T EST battery currently in use 2 Starts printer output activation Used to place the ventilator in the Non ventilate State disabling the delivery of air Standby Enables the ventilator to deliver air to the patient Ventilate 0 Mode Causes the current mode on the display to flash and allows the mode to be changed Setting Switches Volume Mp Inspiratory Time Tj Sensitivity SENS Breath Rate f Pressure P PEEP PEEP Low Pressure Pt High Pressure PT no 0 96 is Ps0 Menu Esc Activates and deactivates the menu on the ventilator s display Used to accept the currently flashing parameter as the new setting Activates display Start Enter 4 Up an
19. Set inspiratory sensitivity to an appropriate level 6 Se pressure support to 0 7 Set PEEP to the level of CPAP required 8 Set the low pressure and high pressure alarm levels See Setting the low pressure alarm on page 4 27 9 If required set available only on Achieva PSO 10 Press Ventilate am to begin breath delivery November 2003 Operation Achieva Ventilator Clinician s Manual Ventilation modes and apnea In Assist Control mode with breath rate settings of less than 6 BPM the ventilator will sound an apnea alarm if no patient effort occurs for 10 1 seconds During an apnea alarm the ventilator delivers controlled breaths at a rate of 10 BPM If the patient initiates a spontaneous breath the ventilator will stop the controlled breaths and return to the previous operating parameters In SIMV mode with breath rate settings of less than 6 BPM the ventilator will sound an apnea alarm if no patient effort occurs for 20 1 seconds During an apnea alarm the ventilator delivers controlled breaths at a rate of 10 BPM If the patient initiates a spontaneous breath the ventilator will stop the controlled breaths and return to the previous operating parameters In Spontaneous mode Achieva PS and Achieva PSO only the user may choose to activate an optional apnea back up rate so that the ventilator will automatically begin to deliver breaths at 10 BPM if no patient effort occurs for 20 1 seconds Upon choosi
20. Ventilator Clinician s Manual Introduction Chapter 1 Introduction This introduction describes the information available in this manual and lists other sources of information about Achieva ventilators It also describes the conventions used throughout this manual Warning You must read and understand all of this manual before you try to operate Achieva ventilators Operating the ventilator without understanding the information in this manual may result in unsafe conditions or misapplication of the device This manual is intended for physicians respiratory therapists and other clinical personnel who use Achieva ventilators It provides detailed information about the installation safe use and verification of Achieva ventilators Since it is not a complete maintenance document it contains no disassembly repair or reassembly instructions or diagrams Use the instructions contained herein in conjunction with those set by the patient s physician No instruction in this manual is intended to replace accepted medical practice regarding the use of the ventilator or the care of the patient November 2003 1 1 Introduction Chapters 1 2 Achieva Ventilator Clinician s Manual The following is a list of the chapters in this manual and a brief description of each Overview This chapter is an overview of Achieva ventilators and includes a comparison of the models It also includes general warnings and cautions as well as i
21. You should consider setting the pressure trig ger when using PEEP This allows the patient to initiate either an Description Note Achieva Ventilator Clinician s Manual assisted or supported breath The pressure trigger will function rela tive to the PEEP setting baseline When using PEEP use the pressure trigger along with sensitivity Flow Trigger The pressure trigger set ting can be accessed and changed as a menu option See Pressure trig ger on page 5 5 Low Pressure P 4 The Low Pressure P 1 limit section of the display shows the mini mal pressure limit that must be exceeded to prevent a Low Pressure alarm The Low Pressure alarm sounds after two consecutive cycles below the low pressure limit The Low Pressure alarm sounds for a val ley alarm after two consecutive breath cycles that do not fall below the low pressure limit See Valley Pressure Alarm on page 6 6 Pressing the Low Pressure PA switch causes the current low pressure limit setting to flash and allows it to be changed When adjusting the Pres sure P setting the Low Pressure P 4 will adjust automatically to at least 1 cmH O above the PEEP setting Some circuit components will prevent a Low Pressure alarm by keeping the pressure in the circuit above the alarm limit Examples of these compo nents include hydrated heat and moisture exchangers HMEs and tracheo stomy tubes If the patient circuit is disconnected from the patient but still connected t
22. and hold Standby 3 seconds or more Reconnect external power If the unit is connected to AC it will automatically exit low power standby mode and begin to charge the internal battery Press Ventilate 0 to resume ventilation If the unit is connected to a charged external battery pres Enter switch to restart The internal battery will not begin to recharge until the ventilator is put into the ventilate mode Press Start Enter and check parameter settings for accuracy Press Ventilate 0 If alarm persists unplug the ven tilator and provide another means of ventilation November 2003 7 1 Troubleshooting Achieva Ventilator Clinician s Manual Conditions Display Message Probable Cause Solution Low Pressure Apnea Alarm P 4 Five pulse audi ble tone with flashing light Apnea Alarm Check sensitivity setting The patient is not breathing Check the patient for breathing effort and stimulate if necessary Water in small bore tubing Inspect and remove water from small bore tubing Kink in small bore tubing Unkink and straighten the small bore tubing Leaks or loose connections in the large bore tubing of the patient circuit Check connection of the patient circuit to the ventilator check all connections for leaks and tight ness especially at the humidifier trach tube and exhalation valve The
23. battery and signal an alarm when the external battery s voltage drops below a preset limit The alarm indicates the ventilator can no longer operate reliably on the external battery External battery precautions Warning Caution Place the battery as far away as possible from the ventilator s Inlet Filter located on the rear panel When using a tray to hold both the battery and the ventilator put a partition between the battery and ventilator Batteries need to be discharged and recharged monthly Refer to the battery instructions Never place the battery above or on top of the ventilator Always use separate batteries to power a motorized wheelchair and the ventilator Internal Battery 24 Volt DC Warning November 2003 Before use run the ventilator on AC power for twelve hours to make sure the internal battery is charged The internal battery can maintain its charge for at most three months when the system is OFF The internal 24 VDC battery is intended for backup use only It requires no special connections The ventilator switches to the internal battery when other power sources fail or drop below adequate levels The Power Switchover alarm signals whenever the ventilator switches from AC or an external DC battery to its internal battery If your health or safety would be jeopardized by a long term power failure a reliable backup power source is mandatory Do not regard the internal battery as a long term ba
24. by pressing and hold ing the ventilate button for one second while the parameter set tings are shown on the LCD display The ventilator will deliver a mandatory breath upon entering Assist Control mode Before the next mandatory breath is delivered check that ethe LED for the Low Pressure alarm lights up ethe LCD display indicates that an Apnea alarm has occurred ethe audible alarm sounds 4 Place the ventilator back in Standby mode by pressing and holding the Standby button for three seconds Reset the alarm November 2003 5 19 Operation Achieva Ventilator Clinician s Manual Power Failure 1 Plug in the ventilator to an AC source and allow it to run in Assist Control mode 2 Unplug the ventilator Check that ethe Power Switchover LED lights up ethe message on the LCD display states that the AC source is no longer powering the ventilator ethe LED power source indicators also indicate that the AC is no longer powering the ventilator ethe audible alarm sounds 5 20 November 2003 Achieva Ventilator Clinician s Manual Operation Continuing Pressure Valley 1 With the ventilator in Standby mode adjust the Volume setting to 200ml and Inspiratory Time to 0 5 seconds 2 Attach an approved breathing circuit to the output port of the ventilator 3 Connect the patient end of the breathing circuit to a 1 liter elastic bag make sure that the pressure tube of the breathing circuit is connected to the app
25. e source or external battery e Bacteria filter e Patient circuit e Air inlet filter e Means of connection to patient November 2003 4 3 Set up Power AC Power Warning Caution Caution Achieva Ventilator Clinician s Manual Any one of three power sources can power the ventilator e External AC e Internal 24 VDC battery e External 24 or 12 VDC battery Use 24 VDC for optimum performance When plugged into a functioning wall outlet the ventilator automatically selects AC power It will operate indefinitely on AC All three sources may be connected to the ventilator at the same time If the AC power fails the ventilator automatically switches to the next best power source The ventilator has a hospital grade 3 pronged AC power connector Note however that the connector s hospital grading depends on its use in a hospital grade outlet If you encounter a 2 pronged outlet have an electrician replace it with a properly grounded 3 pronged outlet Where the integrity of the external protective earth conductor arrangement is in doubt the ventilator shall be operated from its internal electrical power source This equipment must be protectively earthed Mains isolation is accomplished by disconnecting the power cord from AC power The plug may not fit the outlets in some countries There are two solutions Replace the ventilator s plug with one designed for the local outlets or use an adaptor If you
26. flash Audible Alarm Tone The alarm will beep for one second every 30 minutes during a minor fault The alarm will beep once every fifteen minutes if the ventilator is currently ventilating and a seri ous fault is detected The alarm will sound for three seconds if the ventilator is not ventilating and a serious fault is detected Display screen Ventilator hardware error Refer to manual Cause An Equipment failure has been detected Latching Status Non Latching Response to an Equipment Alarm 1 Check the patient circuit and accessory equipment 2 Replace if necessary If the ventilator will not start ventilation and the alarm is beeping once every fifteen minutes contact your equipment supplier November 2003 6 13 Alarms and alerts Achieva Ventilator Clinician s Manual Vent Inop Alarm Visual Indicator The Setting Error light will flash Audible Alarm Tone Five pulses Display screen WARNING Equipment error Refer to Manual Cause An Equipment failure has been detected Latching Status Non Latching Response to a Vent Inop Alarm 1 Switch to an alternate means of ventilation 2 Press the Standby cb switch If this clears the error resume nor mal ventilation If not proceed 3 Unplug the ventilator from AC power and wait 30 seconds with out touching any controls until the unit goes to the OFF state Plug the ventil
27. follow the instructions below eturn the antenna on the affected device e g radio television cordless phone e move the device away from the ventilator econnect the equipment to an outlet which is on a different circuit from the affected device consult the dealer or an experienced radio TV technician for help Software Errors November 2003 The manufacturer has sought to minimize the risks posed by software errors in a number of ways The measures taken include the use of external watchdog circuitry that verifies the operation of the software a redundant timebase and multiple response circuits Ongoing confidence testing is also employed to limit the effect of errors 2 3 Overview Achieva Ventilator Clinician s Manual General warnings and cautions Warnings Cautions The following warnings and cautions apply whenever the ventilator is in use Not to be used in an explosive atmosphere Do not use Achieva ventilators with flammable anesthetic agents Anything that damages the ventilator may cause potential danger to the patient Electric shock hazard Do not operate the ventilator without the covers and panels in place Do not cover or otherwise hinder the flow of air around the ventilator Do not use in direct sunlight in accordance with EN794 2 Use only Puritan Bennett approved accessories with Achieva ventilators Use of other accessories may be hazardous to the patient Do not service Achieva
28. gt EXHAUST FLER PEEP FLOW RESTRICTOR INDUCER l JE Hu PATIENT AIR Tp gt PATIENT 40 MESH FILTER PROX PRESS vso gt 02 VALVE 50 X 250 BLENDER REGULATOR 02 FLOW ZS MESH CNV INDUCER FILTER INLET OUTLET C V PRESS DISS MESH CM TRANSDUCER 02 FILTER CONN 40 MICRON PUMP GEARBOX BRUSHLESS DC MOTOR Blender wo END OF O2 VALVE SENSOR Components November 2003 D 1 Appendix D Achieva Ventilator Clinician s Manual The following is a theory of operation for the pneumatic system in Achieva ventilators For a complete theory of operation see the Achieva Ventilator Technical Manual Text in a sans serif font refers to the labels in the illustration see Pneumatic diagram on page D 1 Air enters the ventilator through a 3 micron inlet filter Negative pressure for entrainment is accomplished by the withdraw stroke of the piston in the mechanical piston pump 7 diameter cylinder Passing through an inlet c v check valve the air enters the cylinder and is mixed with oxygen from the blender The combined gases become pressurized by the forward piston stroke Gas exits through a pump outlet c v check valve and through a 50 X 250 mesh filter Before exiting to the patient through the patient air outlet tube the gas passes through one additional AO mesh filter Ventilator by pass is accomplished by use of a parallel
29. hPa also displays battery charge when TEST BATTERY button is pressed Alphanumeric Display Shows current operating parameters and ventilator information Power Green LEDs indicate operating power source AC AC External Battery EL Internal Battery ED Battery Charging t Green LED indicates the unit is charging the internal battery Assist Spontaneous we Green LED indicates that the patient s effort exceeds the sensitivity setting Alarm Control 9 Red LED flashes at 1 second intervals during a presilence condition and continuously when the non latching alarm feature is active Alarms Flashing red LEDs Low Pressure Apnea P 4 Low Power 4 High Pressure Setting Error 9 Power Switchover 0 Fail 0 Fail available only on Achieva PSO Audible Alarms Relief Valve Test Failure User Self Test Error Leak Test Failure Repeated Single Beep Power switchover Repeated Three Pulses Extremely Low Internal Battery High Pressure Invalid Ratio High Pres lt Low Pres Volume Error Rate Error Inspiratory Error Oxygen Alarm Pressure Differential Error Repeated Five Pulses Low Pressure Valley Exhale Fail Apnea Battery Charge Depleted Vent Inop Continuous Tone Microprocessor failure Single Beep Every Five Minutes Low internal battery One Second Beep Every Thirty Minutes Minor Fault One Beep Every
30. have available in cases of emergency When and how to use a manual resuscitator How to respond fo dyspnea How fo recognize and respond to problems with the ventilator How fo recognize and respond to problems with the oxygen supply How to perform cardiopulmonary resuscitation Techniques fo prevent aspiration of vomit Why and how to use a delee catheter The importance of coordinating care for the patient Resources for respite care Choices about future care L CJ CJ C D CJ CJ O O CJ C OIO O O CI C CI D C C The purpose of advanced directives 5 27 Operation Achieva Ventilator Clinician s Manual 5 28 November 2003 Achieva Ventilator Clinician s Manual Warning November 2003 Alarms and alerts Chapter 6 Alarms and alerts This chapter provides instructions on responding to ventilator alarms A list of all ventilator alarms and alerts is included To manually initiate a test of the alarms press and hold the Alarm Silence Reset agi 60 5 switch when an alarm condition does not exist for at least five seconds The ventilator will activate the audible and visual alarms for a period of one or two seconds Verify that all the visual alarm indicators light up and the audible alarm makes an audible tone If not the ventilator is in need of repair Do not use the ventilator until the problem has been corrected Alerts indicate conditions caused by
31. insufficiencies or failures in a home in an institution or in portable settings Because of their compact design light weight and use of portable oxygen and power sources the units are highly portable Achieva ventilators provide the user with therapeutic support For the user the portability of Achieva ventilators is an advantage over hospital devices The ventilator offers a wide range of delivery volumes inspiratory times and breath rates The doctor respiratory therapist or other care provider can set the appropriate ventilation mode and parameters with the controls on the front panel The magnetically latched door panel and setting switches are designed to prevent tampering and accidental resetting Achieva ventilators are available in three separate models The table on the following page lists the features available with each model The model you have is displayed on the front of the ventilator Overview Achieva Ventilator Clinician s Manual Features of Achieva Ventilators Achieva Achieva PS Achieva PSO Modes of Ventilation Assist Control Yes Yes Yes with Pressure Control Capability Yes Yes Yes SIMV Yes Yes Yes with CPAP Yes Yes Yes with Pressure Support No Yes Yes Spontaneous Pressure Support No Yes Yes with CPAP No Yes Yes Apnea Back Up Rate in spontaneous mode No Yes Yes Dial in PEEP 3 20 hPa Yes Yes Yes Flow Triggering Yes Yes Yes Inter
32. lights indicate which electrical source the ventilator is currently using and if the internal battery is being charged The power lights include AC AC External Battery E37 Internal Battery Battery Charging at Alarm Control Light The Alarm Control light flashes when the audible alarm has been presilenced The Alarm Control M light will light continuously when the non latching audible alarm feature is active See Latching and non latching on page 6 5 Assist Spontaneous 02 Light This LED lights when the patient s inspiratory effort is greater than the sensitivity setting or when the flow and pressure sensors detect a change greater than the flow sensor or pressure trigger setting This is usually an indication of patient effort 3 3 Description Achieva Ventilator Clinician s Manual E The Patient Pressure Meter shows the level of pressure which is currently in the patient circuit When the Test Battery TEST switch is pressed the patient pressure meter shows the charge level of the battery currently in use In some fast cycle situations the meter reading may not reflect the actual pressure When precise pressure readings are required reference the actual values on the display screen Test Battery E_ TEST When the Test Battery ITEST switch is pressed the meter shows the charge level of the battery currently in use The test bat tery switch is also used to activate the ventilator s
33. only with identically rated fuses Warning Before changing the fuse unplug the power cord The fuse holder is located above the power cord connector To remove the fuse holder 1 Insert a small screwdriver into the small slots on the under side of the fuse holder 2 Pull upward with the screwdriver The fuse holder should pop out slightly 4 Pull the fuse holder out 8 4 November 2003 Achieva Ventilator Clinician s Manual 7 November 2003 Maintenance Remove the fuses Place the new fuses directly into the fuse holder Replace the fuse holder in the ventilator You should feel a click when it is secure Reconnect the power cord 8 5 Maintenance Achieva Ventilator Clinician s Manual The ventilator requires Preventive Maintenance at a minimum of once every 6000 operating hours or recertification every twelve 12 months whichever occurs first by service personnel qualified by Puritan Bennett The ventilator is intended to function within its specified parameters if the service schedule is followed Achieva ventilators are warranted against defects in workmanship and materials The full warranty provides details Do not make any service repairs on this equipment during the stated warranty period Any unauthorized work immediately voids the warranty If you need information or assistance or if the information in this manual is insufficient contact Puritan Bennett Puritan Benn
34. path incorporated into the manifold This path bypasses the pump and allows air to move directly to the patient air outlet tube after passing through the 3 micron inlet filter and the ventilator by pass c v check valve This allows the patient to breathe spontaneously in the event of complete ventilator failure The PEEP valve is a voltage sensitive orifice VSO that controls the mushroom valve in the exhalation manifold With the VSO open the mushroom valve is deflated resulting in a PEEP level of 0 hPa With the VSO fully closed the mushroom valve is fully seated and the maximum PEEP pressure in the patient circuit is 20 hPa As a safety measure the VSO is normally open to deflate the mushroom valve This allows the patient in the event of ventilator failure to exhale through the exhalation manifold and inhale through the ventilator The patient flow sensor operates on the principle of heat transfer due to the airflow directed across the surface of the sensing element The patient flow inducer creates a small airflow to feed the sensor by creating a pressure drop across an orifice November 2003 Achieva Ventilator Clinician s Manual November 2003 Appendix D The pressure transducer is connected to the proximal pressure line of the patient circuit The transducer functions from 10 to 100 hPa The secondary pressure transducer is part of the ventilator check for gross failure Pressure differences between the transduce
35. patient s breathing effort is less than the Sensitivity control setting Set the sensitivity so the patient s breathing effort turns on the Assist Spontaneous light or call the doctor Volume set below patient s tidal volume Reset the Volume to the pre scribed value If values are correct call doctor Incorrect control settings Reset all controls to the pre scribed values If values are correct call doctor Obstructions in the patient pres sure tube Check for leaks or kinks in the patient tubing Other causes Notify your physician and your equipment supplier Low Pressure Apnea Alarm Pt Five pulse audi ble tone with flashing light Exhale Fail Alarm Check exhale valve Water in small bore tubing Inspect and remove water from small bore tubing Kink in small bore tubing Unkink and straighten the small bore tubing November 2003 Achieva Ventilator Clinician s Manual Troubleshooting Conditions Display Message Probable Cause Solution Low Pressure Apnea Alarm P 4 Five pulse audi ble tone with flashing light Low Pressure Alarm Attend to patient Water in small bore tubing Inspect and remove water from small bore tubing Patient speech or other activities lower patient airway pressure Low pressure alarm sounds whenever low pressure limit is not reached for two consecutive breaths Review the s
36. properly used this cable and connector prevent reversed connections between the battery and ventilator Use of other cables may damage the ventilator or make it inoperable if the cable connections are accidentally reversed External Battery 12 Volt DC 4 6 The ventilator can also operate from an external 12 VDC battery However a Setting Error alarm is more likely to occur with the use of a 12 VDC battery as the ventilator may not be able to deliver gases at the selected parameters Use of a 24 VDC battery is recommended if at all possible November 2003 Achieva Ventilator Clinician s Manual Set up Battery Performance The internal battery will charge from the external battery only when the ventilator is operating not in Standby but charging from the external battery will reduce the power remaining in the external battery As they age batteries lose their capacity to retain an electrical charge For best performance follow the manufacturer s instructions The following affect the life of the battery e Ambient temperature e Charge level e Storage conditions e Age of battery The number of times and the extent to which the battery is discharged and recharged Type 12 V or 24V To ensure maximum running time of the ventilator on any external battery keep the battery fully charged Some batteries need to be discharged and recharged monthly Refer to the battery manufacturer s instructions Recharge any exte
37. s Manual The following are the labels that appear on your ventilator N WARNING Any device is subject to unpredictable failures ensure patient safety an appropriately trained caregiver should monitor ventilation A AVERTISSEMENT Aucun dispositif n est l abri de pannes ventuelles Pour assurer la s curit du malade confier la surveil lance de la ventilation un soignant ayant recu la formation appropri e Z CAUTION only Read and understand the manuals before operating this device Device Tracking Required Federal Law 21 CFR Part 821 of units that have been repaired by unauthorized personnel This label appears on the inside of the door and provides the following information e The intended use for the ventilator A warning not to use the ventilator where flammable anesthetics are present English and French e A caution against opening the ventilator and against attempting to service it e A warning that the ventilator like all devices can fail unpredictably English and French e A statement that you must read and understand this manual before operating the ventilator This label is located on the top of your ventilator It provides abbreviated information on responding to alarms For more information see Alarms on page 6 1 November 2003 Achieva Ventilator Clinician s Manual NNARNING All alarms indicate a potential risk to patient safety When an alarm sounds provid
38. the Batteries Make sure the battery to be tested is powering the ventilator before performing the battery test failure to do so will result in an erroneous reading of the battery condition To run the test press and hold the Test Battery E IT EST switch The needle on the meter registers the battery charge A fully charged battery in good condition will register approximately 100 on the scale The battery test meter is only a relative indicator of the remaining battery charge An older battery may register a high charge level but discharge more rapidly Carefully monitor battery power sources Always have a back up power source available The amount of power available is directly related to the battery s age as well as the number and depth of cycles the battery has delivered As a battery ages its ability to power the ventilator decreases The extent to which a battery is discharged each time it is used also affects its longevity A battery that is nearly or completely discharged each time it is used will age more quickly than one that is only partially discharged Take both the age of the battery and its history of use into account in all applications but especially in portable applications where another power source may not be readily available The power required by the ventilator varies with the ventilation parameters November 2003 Achieva Ventilator Clinician s Manual Set up The ventilator will switch to the internal
39. transfer OR Press ENTER for remote data transfer Press the Start Enter 1 switch B While the ventilator is sending the data the display will read Sending Data A 4 November 2003 Achieva Ventilator Clinician s Manual November 2003 Appendix A After the Sending Data is displayed and the download is com plete one of the four messages will be displayed Transfer Successful or Transfer Failed Hanging up or Failed to initialize modem or Failed to connect to remote computer Failed to initialize modem indicates a problem with the modem Check switch settings and connections for the external modem If you are using an internal modem contact Puritan Bennett Failed to connect to remote computer Check the connections between the Achieva Report Generator equipped computer and the ventilator Make sure the computer is set to use the correct COM port Retry the transfer See the Achieva Report Generator User s Guide for details A 5 Appendix A Achieva Ventilator Clinician s Manual You can connect the ventilator to a computer through an external modem The phone number for the location of the Achieva Report Generator computer must be entered into the ventilator via a local RS 232 cable connection For more information see the Achieva Report Generator User s Guide Note You cannot start ventilation during a remote data transfer however you can continue ventilation star
40. will not be silenced until the Alarm Silence Reset 67 sos switch is pressed To set the latching status of the alarms 1 Press the Menu Esc key 2 Press the up or down arrow key until the screen displays Press ENTER to change Alarm Latching Status Press che Start Enter 4 1 switch The display indicates the alarm s latching status and gives directions to change the status 4 if you change the latching status of the alarms the ventilator will indicate the new status and ask for the change to be saved Alarms NONLATCHING ENTER save ESC exit Press Start Enter 4 to save the new setting or Menu Esc exit without saving Note If you exit without saving the alarm latching status will not change 6 4 November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Alarm conditions frequently occur during setup of the ventilator Because the audible part of such alarms can be annoying they can be presilenced Pressing the Alarm Silence R eset 67 60 s switch when an alarm condition does not exist and no alarm LEDs are lit will prevent the audible alarm from sounding for one minute The alarm control LED will flash to indicate that the audible alarm has been presilenced Pressing the Alarm Silence Reset 67 sos switch during the presilence condition will cancel the presilence condition If an alarm condition has been corrected while the audible alarm was presilenced the alarms will be reset and th
41. 03 6 15 Alarms and alerts Achieva Ventilator Clinician s Manual Power Switchover Alarm AC Source to External Battery Alarm Visual Indicator Power Switchover light will flash Audible Alarm Tone Repeated single beep Display screen Power source is now the external battery Cause Power is switched from the AC power source to the external battery source Latching Status Non Latching AC Source to Internal Battery Alarm Visual Indicator Power Switchover AC f light will flash Audible Alarm Tone Repeated single beep Display screen Power source is now the internal battery Cause The ventilator switches from an AC power source to the internal battery Latching Status Non Latching External Battery to Internal Battery Alarm Visual Indicator Power Switchover AC gt 71 light will flash Audible Alarm Tone Repeated single beep Display screen Power source is now the internal battery Cause The ventilator switches from an external battery to the internal battery Latching Status Non Latching Response to a power switchover alarm The power switchover alarms are used to indicate that the ventilator has switched to another power source Acknowledge the change by pressing the Alarm Silence reset switch Low Power Alarms During low power conditions other alarms such as Setting Error can occur when the ventilator
42. Achieva Ventilators with Flow Acceleration and Apnea Back Up Clinician s Manual PURITAN BENNETT Copyright 2003 Nellcor Puritan Bennett Inc Pleasanton CA U S A All rights reserved Puritan Bennett is a registered trademark and Achieva is a trademark of Nellcor Puritan Bennett Inc For more information contact your Puritan Bennett Representative Achieva Ventilator Clinician s Manual Oe eee ee er re err rrr rrr eee Bul Chapters ve A eect oem AS eee ene eR 1 2 ole ea eec e 1 4 CONVENTO Sai a RAR ARE AR 1 4 Symbols and their definitions 16 scescesscececescucoseessousccnsssceosessavewevensoecerwauveces 1 5 DUOIVIOW i656 eR RE las Ll FEOS aa eerie ies ec um 2 1 Electromagnetic 2 2 o A A f ata date 2 3 General warnings and cautions 2 4 IF The ventilator fails oae corda tO eSI anre n vain Cert e he C hr ep 2 4 Descriptions sss ooa ARN RIA ia RR NUR CEDE ones 3 1 Iritended USB orae O 3 1 Contra imidicatioris 3 1 Front panels AS As 3 2 TOP PONE ta E Ra 3 2 Controls and display oa 3 5 Back amnd Sides ases vatur or QU erba dide et ct c a 3 10 Inside door label ucro torio AAA 3 12 O 3 12 Sidelabel Ae ira EN 3 13 Agency symbols label iii A a e E EN 3 13 Back panel ER EE AE 3 14 ACCESOS ia as 3 15 SOU iii as idas 4 1
43. Always position the humidifier at a level lower than the patient and at the same or lower level than the ventilator This will help prevent excessive moisture from entering the system Warning Some active humidifiers do not have temperature monitoring or alarm capabilities Failure to monitor air temperature may allow inspired air to become too hot Thermal injury to the patient s airway may result Always follow the recommendations of the humidifier manufacturer Caution Condensation forms in the patient circuit over time Periodically check for moisture in the patient circuit When present remove the moisture Before November 2003 4 17 Set up Achieva Ventilator Clinician s Manual attempting to dry the circuit disconnect it from the ventilator Warning Do NOT use compressed gas to clear moisture from the pressure line when connected to the patient First disconnect the ventilator and circuit Warning Always drain the tubing away from the patient connection Caution Always disconnect the tubing from the ventilator before drying with pressurized air Failure to do so may damage the ventilator 4 18 November 2003 Achieva Ventilator Clinician s Manual Set up Connecting to a nurse call system The nurse call output on the back of Achieva ventilators is connected to the contacts of a normally open relay During low pressure alarms the contacts open and close 1 67Hz 50 duty cycle During all other alarms the cont
44. ENT ru UNE PROTECTION TSE DES FES D MAE rl RASE SOT 2S0 V Ch 2154 ACTON ante 50 40 Hz Dy TISA A Inlet filter Filters air as it enters the ventilator B Power cord connector External battery connector Used for connecting an external battery D Side rails Used for mounting some accessories on the ventilator E Audible alarm port on side of ventilator DO NOT BLOCK F Communications connector This connector is used to connect a printer external modem or a computer with the Achieva Report Generator software directly to the ventilator Follow the accessory manufacturer s connection instructions for the appropriate connection procedure G Nurse call output The ventilator can be connected to nurse call stations through this output See Connecting to a nurse call system on page 4 19 November 2003 Achieva Ventilator Clinician s Manual Note Note November 2003 Description Remote alarm connector The remote alarm cable plugs into the remote alarm cable jack on the back of the ventilator Be sure it is firmly in place The cable slips in only if you have the button on the end of the connector facing down To remove the cable from the ventilator press the button and pull the connector straight out Modem connector North America only Outside North America use an external modem For all models there is a label but no connector J Oxygen input connection only
45. M Where LPM 100 oxygen flow in liters per minute BPM breath rate in breaths per minute V tidal volume in liters C desired patient oxygen concentration i e 30 0 3 Oxygen bled into the circuit is additional volume Adjust for this volume when setting the ventilator volume Oxygen enrichment kit You can achieve high oxygen concentrations at the proximal airway by delivering source oxygen directly into the Air Inlet port on the back of the ventilator Use the optional Oxygen Enrichment Kit This kit contains complete instructions 4 16 When using humidification for a short time or during transport you can use a heat and moisture exchanger HME or artificial nose with the ventilator Connect this regenerative humidifier to the patient circuit between the trach connector and the flextube or follow the manufacturer s instructions November 2003 Achieva Ventilator Clinician s Manual Set up Warning The use of an HME or humidifier may affect the ventilator s low pressure alarm See Setting the low pressure alarm on page 4 26 Extended Use The patient s doctor will usually prescribe humidification of the delivered gases Puritan Bennett offers special humidifier mounting brackets The brackets include instructions for use For complete instructions on the operation cleaning and sterilization of the humidifier refer to the appropriate sections of the humidifier manufacturer s instruction manual Warning
46. Ventilation mode Alphanumeric 1000 1 5 60 5 and parameter display 15 20 20 10 60 1 17 98 C JL JUL JC JL J LJ Ventilator fl P PEEP A Pt WE 0 controls n In the standby mode of operation the ventilator does not deliver air to the patient The ventilator can be kept in the standby mode indefinitely when it is connected to AC power While on Standby the ventilator charges the internal battery and the power indicators AC AC and Battery Charging At will light When powered from a battery the ventilator will remain in standby for 30 seconds and then switch automatically to the low power mode Press the Start Enter switch to bring the ventilator out of the low power mode November 2003 5 1 Operation Achieva Ventilator Clinician s Manual To start the ventilator 1 Press the Start Enter switch The ventilator will be in Standby and the current parameter set tings will be displayed 2 Check to make sure the parameters are set according to the physi cian s prescription If the parameters are set incorrectly adjust them at this time See Operating the controls on page 4 22 Press the Ventilate switch to start ventilation As ventilation starts check the following The ventilator s LEDs will light and an audible alarm will sound for one second Then ventilation will begin Verify that
47. acts remain closed The contacts are also closed while the ventilator is in Standby non ventilate mode Pressing the Alarm Silence Reset 67 60 5 button resets the contacts in the open position Use a 14 phone plug available from Puritan Bennett to connect this output to a nurse call station The relay is rated at 30V 0 5A If your application requires a normally closed open on alarm connection you can change the setting by following these instructions 1 Make sure the ventilator is unplugged and fully powered down no power source LED lit 2 Use a 1 8 hex driver to remove the two screws securing the left side rail and the left side cover the side with the alarm Remove the left side rail 3 Remove the plastic left side cover November 2003 4 19 Set up 4 20 4 7 Achieva Ventilator Clinician s Manual There is a label on the left side panel that looks like the sample shown below Nurse Call System E NC NO Connector HIGH Configuration e a OL Position 00 N O em LOW Position e X Insert a small nonconductive screw driver through the left adjust ment hole in the side panel and slide the switch to the right until it clicks into position The right adjustment hole is for changing the alarm volume level Insert the tabs on the bottom of the plastic left side cover into the groove at the bottom of the left side panel
48. all the LED indicators light up and the alarm sounds an audible tone If not the ventilator is in need of repair Do not use the ventilator until the problem has been corrected Read the pressure trigger and altitude settings that flash on the display when the Ventilate 0 switch is pressed Verify that these settings agree with the prescribed values For the patient s safety when the ventilator is plugged into AC or switched up from low power mode the ventilator releases the first breath through the exhalation manifold The unit s microprocessor requires one cycle to establish its reference point that is the operating mode and set tings to use This operation prevents delivery of incorrect volumes that could result in excessive pressure build up Stopping the ventilator To stop the ventilator disconnect the ventilator from the patient Then press and hold the Standby switch for at least three seconds Note The ventilator can remain in standby indefinitely when connected to AC power While in Standby the ventilator charges the internal battery and 5 2 November 2003 Achieva Ventilator Clinician s Manual Operation the power indicators A C AO and Battery Charging fg will light When connected to battery power internal or external the units will be on Standby for 30 seconds then switch to the low power mode Sensitivity and adjustment By default Achieva ventilators use flow to trigger patient initiated
49. ange the humidifier or HME How fo recognize and respond to problems with the humidifier or HME The oxygen setting and why it is required How to connect the oxygen source to the ventilator How to determine the amount of oxygen available and how to acquire more Safety rules for the use of oxygen Why a back up ventilation system is necessary and how to use it How the back up ventilation system differs from the main system How to recognize and respond to problems with the back up ventilation system C Cl C CI C C C CI O C O C How to use additional equipment such as external monitors and alarms 5 26 November 2003 Achieva Ventilator Clinician s Manual November 2003 Operation he patient and caregiver must understand fow and Wy monitor me patient s condition How to check the patient s vital signs The significance of the patient s ease of breathing What to note about the patient s skin mucous membranes and secretions with their significance How to recognize the signs of infection and how to respond The importance of routine medical appointments and medical testing The need and processes used to clear airway secretions The use of manually assisted coughing When why and how to use tracheal suctioning How fo recognize and respond to problems with suctioning quipment and phone numbers to
50. anual Start of inspiration End of inspiration I V I I I I I l l I I I V I I I I I Time D 10 November 2003 Achieva Ventilator Clinician s Manual November 2003 Appendix D In SIMV mode the ventilator delivers volume breaths as determined by the Breath Rate setting with all additional breaths delivered as pressure supported breaths See Pressure supported breaths on page D 13 In the waveforms on the opposite page the breath in the first machine calculated breath time is due to a lack of patient effort in the preceding machine calculated breath time that is the first breath shown is actually associated with a preceding machine calculated breath time for simplicity we will use the term period for machine calculated breath time The second breath shown is delivered because of the absence of patient effort in the first period shown Before the next period elapses the patient initiates an assisted volume breath Although it continues into the third period it fulfills the requirements of the second period The second patient initiated volume breath fulfills the requirements of the third period Therefore the ventilator does not deliver another breath until the fourth period has elapsed The patient initiated breath that starts in the fifth period fulfills the requirements for the fifth period The first patient initiated breath in period six fulfills the requirements for period six therefor
51. ated breath time Following the second controlled breath but before another period can elapse the patient s effort triggers an assisted or patient initiated breath This restarts the period At the conclusion of the period the ventilator delivers another controlled breath Period Period Period H deal I Machine breath Machine breath IMachine breat Time November 2003 Achieva Ventilator Clinician s Manual Pressure controlled in Assist Control mode November 2003 Appendix D In Assist Control mode with Pressure set greater than 0 each delivered breath will maintain the selected Pressure maintained over the selected Inspiratory Time Inspiration is triggered by patient generated flow or pressure drop for assisted breaths or by the ventilator for controlled breaths Breath Rate is the controlling parameter For both controlled and assisted breaths the inspiratory pressure is limited to the Pressure setting and is cycled by time Inspiratory Flow Acceleration and Expiratory Sensitivity Inspiratory flow acceleration controls flow and increases pressure rise time during a pressure supported or pressure controlled breath By selecting the inspiratory Flow Acceleration feature the operator can control flow during pressure supported and pressure controlled breaths The inspiratory flow acceleration feature has settings of ON or OFF When the flow acceleration feature is ON the actual flow rate during inspirat
52. ator into AC power and resume normal ventilation If the alarm has not cleared proceed to the next step 4 Unplug the ventilator from AC power press and hold Standby cb for three or more seconds Plug the ventilator into AC power and resume normal ventilation If che alarm has not cleared con tact your equipment supplier 6 14 November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Oxygen Alarm Oxygen Alarm Visual Indicator j light will flash Audible Alarm Tone Three pulses Display screen WARNING Oxygen error Attend to patient Cause The O Fail alarm will sound if the ventilator does not detect a flow source at the oxygen connector Latching Status Non Latching Response to an Oxygen Alarm 1 Attend to patient first 2 Check and correct the connections to the oxygen source Check the oxygen setting 4 Check the oxygen supply If the supply is empty switch to an alternate oxygen source If there is an oxygen alarm in the absence of other alarm conditions or if there is a problem with the oxygen supply oxygen settings or the ventilator contact your equipment supplier Warning This device does not include an oxygen analyzer Always measure the delivered gases with a calibrated analyzer having high and low concentration alarms in order to ensure that the prescribed oxygen concentrations are delivered to the patient November 20
53. ator to deliver one breath During the inspiratory phase of the breath occlude the patient end of the breathing circuit and check that ethe LED for the Setting alarm lights up a High Pressure alarm will accompany the Setting alarm ethe LCD display indicates that an Inspiratory Time alarm has occurred ethe audible alarm sounds Remove the occlusion and set the ventilator to Standby mode by pressing and holding the Standby button for 3 seconds Reset the alarm This concludes the Monthly Safety Check If the ventilator fails the monthly safety check or you cannot complete this check refer to the Troubleshooting Chapter of this manual or call your equipment supplier or Puritan Bennett The following items are set from the menu To access the menu press the Menu Esc switch This selection is only available if you press the Menu ESC switch while the ventilator is on Standby The user self test includes a circuit leak test and a pressure relief valve test For more information User self test on page 4 23 Ventilating hours 5 22 The ventilator hours menu selection allows you to see the number of operating hours on the ventilator since the last preventive maintenance To November 2003 Achieva Ventilator Clinician s Manual Operation keep the ventilator operating within specifications preventive maintenance must be performed every 6000 operating hours or recertification every twelve 12 months whichever occ
54. auses the current set value for sensitivity to flash and allows it to be changed Sensitivity F P or M The letters P M on the alphanumeric display indicate whether breath cycles are initiated by the patient F standing for Flow P for Pressure or by the ventilator M for Machine breath When using PEEP use the pressure trigger along with sensitivity Flow Trigger The pressure trigger setting can be accessed and changed as a menu option See Pressure trigger on page 5 5 Breath Rate f The Breath Rate f section of the display screen shows the rate at which volume and pressure control breaths are delivered After enter ing Spontaneous mode use the up and down arrows to select Y or N in the alphanumeric display to activate or deactivate the auto matic apnea back up rate Pressing the Breath Rate f switch causes the current set value for breath rate to flash and allows it to be changed Pressure P The Pressure P section of the display shows the pressure level main tained during either a pressure supported breath or a pressure con trolled breath Pressing the Pressure P switch causes the current set value for pressure to flash and allows it to be changed PEEP The PEEP Positive End Expiratory Pressure section of the display screen shows the pressure maintained at the end of a delivered breath Pressing the PEEP switch causes the current PEEP setting to flash and allows it to be changed
55. breath is a volume breath SIMV mode the breath rate is slower than the Breath Rate set ting or Ifthe breath is an assisted breath SIMV mode the breath rate is slower than two times the Breath Rate setting Latching Status Non Latching Inspiratory Error Alarm Visual Indicator The Setting Error light will flash Audible Alarm Tone Repeated single beep Display screen WARNING Inspiratory time error Attend to patient Cause During volume breath delivery the last measured inspiratory time differed by 12 from the inspiratory setting Latching Status Non Latching Inspiratory Error Alert Visual Indicator The Setting Error light will flash Audible Alarm Tone No audible alarm tone Display screen WARNING Inspiratory time error Attend to patient Cause During pressure controlled breath delivery the measured inspiratory time differed by 12 from the inspiratory setting for the last two consecutive breaths Latching Status Non Latching Response to a Setting Error Alarm 1 Attend to patient first 2 Check the ventilator settings Correct any setting errors 4 Ifthe ventilator s settings are set according to a doctor s prescrip tion contact your doctor or equipment supplier 6 12 November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Equipment Alarm Visual Indicator The Setting Error light will
56. ckup power source When powered by the internal battery the Internal Battery EJ light is continuously lit As the battery nears depletion the ventilator will give the Set up Note Note Caution 4 10 Achieva Ventilator Clinician s Manual following alarm indications times are based on normal load conditions as defined in Appendix E Specifications Low Internal Battery Alarm When approximately 45 minutes of power remains the audible alarm sounds a single beep every five minutes Switch to an external power soutce Extremely Low Internal Battery Alarm When approximately 10 minutes of power remains the low power light flashes and the alarm sounds three pulses repeating which can be silenced for five minutes at a time by pressing the Alarm Silence R eset uj 60 5 switch Switch immediately to another power source Battery Charge Depleted When the internal battery is nearly depleted the Low Power a 4 light continues to flash and the alarm sounds five pulses repeating that cannot be reset or silenced You must respond immediately and provide another source of ventilation Switch to an external power source and reset the ventilator For instructions on how to recover from this condition see Response to Low Internal Battery Power or Extremely Low Internal Battery Power alarms on page 6 18 During Low Battery and Extremely Low Battery alarms other alarms such as Setting Error can occur when the ven
57. d Down Arrow Keys Increases or decreases the parameter settings or menu levels Pressing when the sub menu is not active and a parameter has not been selected will cause the last alarm message to be displayed Settings For Assist Control 50ml to 2200ml in 10 ml steps For SIMV 50ml to 1750ml in 10 ml steps Volume Vy Accurate to 10 ml for 50 100 ml and 10 96 max 75 ml for 100 2200 ml of the setting to a maximum delivered volume error of 75 ml e ini 0 Inspiratory Time T 0 2 to 5 0 seconds in increments of 0 1 seconds Accurate to 10 Tn Flow 3 to 25 LPM in 1 LPM increments Accurate to 2 0 LPM Off or 1 to 15 hPa in 1 hPa Sensitivity SENS increments Accurate to 2 5 hPa 1 BPM to 80 BPM in steps of 1BPM Accurate to 10 or 1 BPM which ever is greater Breath Rate f i d Pressure P 00 50 hPa in 1 hPa increments Accurate to 2 5 hPa of the setting once the pressure reaches the setting PEEP 0and3to 20 hPa in 1 hPa increments Accurate to 2 5 hPa 1 to 59 hPa in increments of 1 hPa Activates within 2 5 hPa Low Pressure 4 2 to 80 hPa in increments of 1 hPa Activates within 2 2 5 hPa High Pressure Flow Acceleration OFF or ON Inspiratory Flow lt 180 Ipm Expiratory Trigger 15 to 55 in increments of 10 Accurate to 15 at 15 to 5 at 25 55 November 2003 E 3 Appendix E Achieva Ventilator Clinician s Manual 0 Level 0 Achieva PSO 21 to 100 for tidal
58. d volume 6 Set the prescribed inspiratory time J Set the inspiratory sensitivity to an appropriate level 8 Set the breath rate for the prescribed number of volume breaths per minute All other breaths delivered will be pressure supported breaths 9 Set both pressure support and PEEP to the prescribed level of pres sure support 10 Ser the low pressure and high pressure alarm levels See Setting the low pressure alarm on page 4 27 11 If required set available only on Achieva PSO 12 Ser the Expiratory Sensitivity 13 Press Ventilate am to begin breath delivery November 2003 5 11 Operation Achieva Ventilator Clinician s Manual SIMV mode with CPAP To operate the ventilator in SIMV mode with CPAP 2 3 5 6 7 8 12 13 Press MENU ESC to enter the ventilator s menu system Set alarm latching see Latching and non latching on page 6 5 or pressure trigger level see Pressure trigger on page 5 5 and or operating altitude see Altitude setting on page 5 6 from the menu as needed From standby press Start Enter 4 to display the parame ters Set MODE to SIMV Set the prescribed volume Set the prescribed inspiratory time Set inspiratory sensitivity to an appropriate level Set the breath rate to the prescribed number of volume breaths per minute All other breaths delivered will be CPAP supported breaths Set pressure support to 0 Set PEEP to the prescrib
59. delivers an assisted breath The Sensitivity SENS switch sets the flow in liters per minute the patient must generate to trigger inspiration The clinician can also set the pressure below the baseline that will trigger inspiration Pressure triggering may result in greater sensitivity to patient demand in low flow conditions When using PEEP use the pressure trigger along with sensitivity Flow Trigger The pressure trigger setting can be accessed and changed as a menu option See Pressure trigger on page 5 6 Spontaneous ventilation mode that delivers assisted breaths only Spontaneous mode does not provide breaths if the patient does not make an inspiratory effort greater than the sensitivity settings and the apnea backup is off but an apnea alarm will occur Standby The operational mode of the ventilator where it is connected to p power but is not ventilating the patient Synchronous Intermittent Mandatory Ventilation SIMV ventilator mode which provides a mechanism for synchronizing the ventilator delivered breaths with a patient s inspiration as detected by the ventilator Tidal volume Volume of gas entering or leaving the patient User selftest A ventilator test performed with user assistance that checks for leaks in the patient circuit and tests operation of the high pressure relief valve Appendix B B 4 Achieva Ventilator Clinician s Manual Volume breath Inspiration of the selected volume deliv
60. e the second patient initiated breath in period six is delivered as a pressure supported breath Because of the patient activity in period 6 no breath is delivered in period seven therefore a breath is delivered at the start of period eight to fulfill the requirements of period seven In SIMV mode for Achieva PS and Achieva PSO spontaneous breaths are supported to the baseline pressure either O hPa or if used the selected PEEP setting D 11 Appendix D D 12 Period 1 Machine breath Period 5 Machine breath Period 2 Period 3 Machine Patient assist breath breath breath Time Period 6 Period 7 1 Patient assist Patient breaths breath Time Achieva Ventilator Clinician s Manual Period 4 Patient assist Period 8 Machine breath November 2003 Achieva Ventilator Clinician s Manual Pressure supported breaths November 2003 Appendix D In SIMV or Spontaneous modes the supported breaths maintain the selected pressure Inspiration is triggered by patient generated flow or pressure drop When Flow Acceleration is on maximum flow is limited to 180 lpm When Flow Acceleration is off the maximum flow is delivered and is cycled by the patient when flow drops to the Expiratory Sensitivity setting between 15 and 55 of peak flow In SIMV additional mandatory volume breaths will be delivered dependent on the selected Breath Rate See Mandatory
61. e exhalation valve is a critical component During pressure ventilation and PEEP the exhalation valve is controlled to regulate pressure and PEEP B FLEX TUBE This tube connects the patient circuit to the tracheostomy tube The tube s flexibility makes the circuit more comfortable The flex tube may contain natural rubber latex which may cause allergic reactions BACTERIA FILTER This filter cleans the incoming air before the patient inhales it D PATIENT AIR TUBE This is the large tube between the bacteria filter and the exhalation manifold Anti static or conductive hoses or tubing should not be used E PATIENT PRESSURE TUBE This small tube connects the patient pressure port on the ventilator to the proximal pressure port on the exhalation manifold F EXHALATION TUBE This small tube connects the exhalation valve port to the mushroom valve in the patient circuit Ensure the proper connection and operation of the patient circuit at least daily The patient could be at risk if the manifold does not function as intended Connecting patient pressure and exhalation tubes to the incorrect port prevents proper patient ventilation Be aware that adding attachments or other components to the breathing system will increase inspiratory and expiratory resistances Set up Warning Warning 4 14 Achieva Ventilator Clinician s Manual A ventilator patient is highly susceptible to respiratory infections Dirty or contaminated
62. e immediate attention care and support to the patient as dictated by the situation FIVE PULSES FLASHING LIGHTS Low Pressure Apnea Check for correct secure patient amp ventilator hose connections Inspect and remove water from small bore tubing Confirm correct selection of low alarm settings AWARNING The low pressure alarm setting should be adjusted to a value just below the pressure necessary for proper patient Setting Error bd Check that settings are appropriate for equipment capabilities Check for mechanical or electrical failure High Pressure Check for obstructed or crimped tubing Check patient for trach obstruction Check exhalation manifold for proper function Confirm correct selection of high alarm settings ventilation Repeated Single Beep Flashing Lights Depleted Internal Battery Power Switchover Immediately connect to adequate power supply Unit has switched from AC power to battery power source Operate ventilator on AC power to recharge the internal battery or from external to internal battery A fully depleted internal battery will be fully charged in 12 hours Monitor battery power and provide adequate back up power THREE PULSES FLASHING LIGHTS Single Beep Low Power When the internal battery is powering the ventilator a single Immediately connect to adequate power supply reminder tone is heard every five minutes when the battery has Operate the vent
63. e lights will be deactivated Pressing the Alarm Silence Reset Mb sos switch after an alarm condition has been corrected will reset the alarms and deactivate the lights November 2003 6 5 Alarms and alerts Achieva Ventilator Clinician s Manual Alarm conditions Low Pressure Apnea Alarms Low Pressure Alarm Visual Indicator Low Pressure Apnea P 4 light will flash Audible Alarm Tone Five pulses Display screen WARNING Low Pressure Attend to patient Cause A low pressure alarm condition exists if the proximal pressure does not rise above the low pres sure setting during the last two consecutive breath cycles The exception is in SIMV mode when the Low Pressure alarm setting is higher than the Pressure setting Then the Low Pressure alarm will occur if the peak proximal pressure of the last two consecutive volume breaths never rises above the Low Pressure setting Latching Status Latching Non Latching Valley Pressure Alarm Visual Indicator Low Pressure Apnea P 4 light will flash Audible Alarm Tone Five pulses Display screen WARNING Valley Pressure Alarm Attend to patient Cause A valley pressure alarm condition exists if the proximal pressure does not drop below the low pressure setting during the last two consecutive machine breaths Latching Status Latching Non Latching Exhale Fail Alarm Visual Indicator Low Pressure Apnea P 4 light will
64. eat and moisture exchangers HMEs and tracheostomy tubes For all ventilator patients who cannot respond appropriately to this situation the clinician must set the low pressure alarm to a level that permits an alarm to be detected in the event of a disconnection Before adjusting the low pressure alarm keep these points in mind e The low pressure alarm must be set for the exact configuration of patient circuit components including the tracheostomy tube and the mode of ventilation If you add remove or change components readjust the low pressure alarm When PEEP is used the low pressure alarm setting cannot be set lower than the PEEP setting The settings will flash together if you try to set the low pressure alarm below the PEEP setting e The HME is a substitute for an active humidifier do not use the two together e The 5 resistance to air flow increases as it becomes moist with use After a period of time which will depend on the patient and the HME the low pressure alarm must be readjusted Consult your doctor and the manufacturer of the HME to determine the appropriate period November 2003 Achieva Ventilator Clinician s Manual Set up Follow these steps to set the low pressure alarm 1 Assemble the patient circuit exactly as it will be used by the patient Attach all accessories including the HME if used the tracheostomy tube or inner cannula of dual lumen tracheostomy tubes 2 Verify that the
65. ection on alarms Kink in small bore tubing Unkink and straighten the small bore tubing Leaks or loose connections in the large bore tubing of the patient circuit Check connection of the patient circuit to the ventilator check all connections for leaks and tight ness especially at the humidifier trach tube and exhalation valve Incorrect control settings Reset all controls to the pre scribed values If values are correct call doctor Obstructions in the patient pres sure tube Check for leaks or kinks in the patient tubing Other causes Notify your physician and your equipment supplier Low Pressure Apnea Alarm Pt Five pulse audi ble tone with flashing light Valley Pressure Alarm Attend to patient Water in small bore tubing Inspect and remove water from small bore tubing Kink in small bore tubing Unkink and straighten the small bore tubing Incorrect control settings Reset all controls to the pre scribed values If values are correct call doctor Other causes Notify your physician and your equipment supplier Low Power 4 alarm Beep or repeating beep with flashing light Low Internal Battery Power OR Extremely Low Internal Battery Power OR Battery Charge Depleted Failure to recharge the internal battery Plug ventilator into AC power OR Plug ventilator into a charged external battery
66. ed level of CPAP Set the low pressure and high pressure alarm levels See Setting the low pressure alarm on page 4 27 If required set F O available only on Achieva PSO Press Ventilate am to begin breath delivery November 2003 Achieva Ventilator Clinician s Manual Operation Spontaneous mode with pressure support Flow acceleration When using pressure control in the Spontaneous mode you can set the ventilator to limit the inspiratory flow rate The flow acceleration can be turned on or off When flow acceleration is off the ventilator delivers maximum flow with relatively little pressure integration When on the maximum flow is metered to 180 lpm For more information on Flow acceleration see Limiting inspiratory flow Flow Acceleration on page 5 8 To operate the ventilator in spontaneous mode with pressure support Achieva PS and Achieva PSO 2 3 7 November 2003 Press MENU ESC to enter the ventilator s menu system Press the up or down arrow keys until the display shows the message Press ENTER to change flow acceleration Press the START ENTER key The display shows the current setting Flow acceleration OFF UP DN change ENTER keep Use the up and down arrow keys to enable ON or disable OFF flow acceleration Press START ENTER to accept the setting Set alarm latching see Latching and non latching on page 6 5 or pressure trigger level see Press
67. elections The control display panel is located behind the ventilator s front door panel After beginning a ventilating mode the display panel shows the set values for tem seconds and then displays the actual values for each parameter The set value also appears for ten seconds after the value of a setting is changed or the Start Enter switch is pressed Certain parameters such as the low pressure and high pressure alarm settings do not have an actual value For these dashes are displayed instead Following is a description of the switches functions For further details see Operating the controls on page 4 21 Standby 05 Use the Standby switch to place the ventilator in the standby mode a state where air is not being delivered Ventilate 0 Use the Ventilate 0 switch to deliver air to the patient November 2003 3 5 Description Achieva Ventilator Clinician s Manual Menu Esc The Menu ESC switch activates the menu options on the ventilator s display Up and Down arrow keys The up and down arrow keys operate in three ways eWhen a ventilation parameter is flashing use the up down keys to scroll to the required setting When the MENU ESC button has been pushed use the up down keys to scroll to the required menu Pressing the up down keys when neither a menu nor a parameter is active will cause the last alarm message to be displayed Start Enter 4 1 When the ventilator is in Standby
68. entilator dependent children Editor 71 Maple St Oneonta NY 13820 607 432 8872 I V U N International Ventilator Users Network Links ventilator users with each other and with home care professionals interested in home mechanical ventilation Publishes spring and fall issues of I V U N NEWS Publisher Gazette International Networking Institute GINI 5100 Oakland Ave 206 St Louis MO 63110 314 534 1475 Contact Executive Director National Spinal Cord Association This is a membership consumer based organization whose purpose is to address the needs of persons with spinal cord injury or disease which includes many ventilator dependent individuals The association conducts programs in the area of research and services includes a network of local chapters providing direct services and compiles a resource directory The directory provides information on services programs and resources available for persons with limited mobility Address 600 W Cummings Park Suite 2000 Wooburn MA 01801 617 935 2722 November 2003 Achieva Ventilator Clinician s Manual Appendix D Appendix D Theory of operation This appendix provides an operating theory for Achieva model ventilators It includes a description of the ventilation modes and sample waveforms SECONDARY EXHALATION VALVE CONTROL HIEN PRESSURE PRESSURE TRANSDUCER bs RELIEF VALVE 4 3 MICRON TEMA cL
69. ered over the selected inspiratory time Warning Directions that warn of conditions that put the patient caregiver or other individuals at risk of injury November 2003 Achieva Ventilator Clinician s Manual Appendix C Appendix C Resources This chapter provides a brief bibliography and a list of organizations of interest to clinicians caregivers and patients Bibliography ACCP Consensus Conference on Mechanical Ventilation Respir Care 1993 38 1389 1417 Consensus Conference on the Essentials of Mechanical Ventilators Respir Care 1992 37 999 1130 special issue Murray JE Payment Mechanisms for Pediatric Home Care Caring Oct 1989 33 35 The National Center for Home Mechanical Ventilation Learning Objectives for Positive Pressure Ventilation in the Home Denver CO 1993 Puritan Bennett s Ventilator Users Network Network of healthcare professionals with the purposes of aiding communication among clinicians regarding special ventilator applications sharing news on ventilation and working together to meet the needs of ventilated individuals and improve their quality of life Contact Tyco Healthcare Group LP Nellcor Puritan Bennett Division 4280 Hacienda Drive Pleasanton CA 94588 800 635 5267 November 2003 C 1 Appendix C Achieva Ventilator Clinician s Manual Congenital Central Hypoventilation Syndrome CCHS Family Network Publishes the CCHS Family Network Newsletter and supports camps for v
70. et and minimum pressure actual e high pressure setting set and maximum pressure actual average expiratory and inspiratory pressures actual for each November 2003 Achieva Ventilator Clinician s Manual Appendix A Local data transfer You can connect the ventilator directly to the computer through the ventilators communications port on the back panel For more information on the Report Generator see the Achieva Report Generator User s Guide Note You cannot start ventilation during a local data transfer however you can continue ventilation started before the data transfer 1 Connect one end of the RS 232 communications cable to the com munications port on the back of the ventilator 2 Connect the other end of the cable to the computer s COMI or other COM port as selected in the Report Generator software Note Your computer may require a 9 pin to 25 pin adaptor On the computer start che Report Generator software 4 On the main Report Generator display select Connection and Local Connection The computer will display Connected to VEN ventilator serial number Patient patient name B the computer click OK November 2003 A 3 Appendix A Achieva Ventilator Clinician s Manual Download procedure 1 On the ventilator press the Start Enter el switch 2 Press the Menu ESC switch Press the up or down arrow keys until its display screen reads Press ENTER for local data
71. ett does not recognize the owner of a ventilator as an authorized service representative Puritan Bennett will not be liable for any repairs attempted by the owner Any such attempted repairs other than specified non warranty repairs void the warranty Parts and labor costs incurred by the owner will not be reimbursed by Puritan Bennett Before returning any device to Puritan Bennett you must get a Return Authorization Number by calling Puritan Bennett 8 6 November 2003 Achieva Ventilator Clinician s Manual Appendix A Appendix A Ventilator data This chapter tells how to print a report from the ventilator and describes the information in that report It also describes how to transfer information from the ventilator to a computer equipped with the Achieva Report Generator software Achieva ventilators store data which can be used to evaluate the ventilation program Some information is available in a report that can be printed directly from the ventilator More complete reports can be made with the Achieva Report Generator software For more information on the Report Generator see the Achieva Report Generator User s Guide Printing reports from the ventilator You can use a printer to create a permanent copy of the patient information and ventilator operation The printer must be Epson compatible with a serial input or a serial to parallel adaptor 1 Connect a printer to the Communications port on the back of the ventila
72. etween the patient air port and the blockage you created at the exhalation manifold Acknowledge the alarm condition by pressing the ALARM SILENCE RESET switch The display screen will indicate that the test was a failure November 2003 Achieva Ventilator Clinician s Manual Set up Test FAILED ENTER repeat ESC exit e Press START ENTER to repeat the test e If the ventilator fails the test again try using a new patient circuit and repeat the test If the ventilator fails with a new patient circuit contact your equipment supplier or Puritan Bennett Relief valve test FAILED Refer to MANUAL If this message is displayed it means that the ventilator s relief valve did not function properly e If the ventilator fails the test again contact your equipment supplier or Puritan Bennett November 2003 4 25 Set up Achieva Ventilator Clinician s Manual Setting the low pressure alarm Warning Warning 4 26 Throughout this procedure the ventilator must be disconnected from the patient Provide another means of ventilation Some patients will be in danger if they become disconnected from the ventilator The purpose of the low pressure alarm is to detect such a disconnection but the ventilator can only do so if it is adjusted properly Some patient circuit components can defeat a low pressure alarm by keeping the pressure in the circuit above the alarm limit Examples of such components include hydrated h
73. f alarm remains disconnect the ventilator from the patient Then press and hold Standby b for 3 seconds If alarm clears press Ventilate If alarm didn t clear disconnect external power After all lights are off reconnect external power and press Ventilate n If alarm returns notify your phy sician and equipment supplier Green AC Power O light does not glow No display message AC power cord is not connected Plug in the cord The ventilator s fuse has been blown Replace the fuse see Changing the fuse on page 8 5 No power to the wall outlet Use an adive outlet November 2003 Achieva Ventilator Clinician s Manual Troubleshooting Conditions Display Message Probable Cause Solution 0 Fail Alarm Three pulse audi ble tone with flashing light Oxygen error Attend to equip ment Low 0 source pressure 0 source disconnected 0 source empty Increase 02 source pressure Connect an 02 source Replace 0 source November 2003 7 5 Troubleshooting Achieva Ventilator Clinician s Manual 7 6 November 2003 Achieva Ventilator Clinician s Manual Maintenance Chapter 8 Maintenance This chapter provides cleaning and maintenance information a list of replaceable parts and a maintenance schedule Cleaning and sterilization Warning Caution Caution November 2003 This section co
74. flash Audible Alarm Tone Five pulses Display screen WARNING Exhale Fail Alarm Check exhalation valve Cause An Exhale fail alarm condition exists when at the start of the inspiratory cycle the pressure in the patient s circuit is greater than or equal to the high pressure alarm setting Latching Status Latching Non Latching 6 6 November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Apnea Alarm Visual Indicator Low Pressure Apnea P D light will flash Audible Alarm Tone Five pulses Display screen WARNING Apnea Alarm Check sens setting Cause Anapnea alarm condition exists when there is no patient breathing effort or machine cycle for 10 seconds while in Assist Control Mode or 20 seconds in SIMV or Spontaneous modes Latching Status Latching Non Latching User Self Test Error Visual Indicator Low Pressure Apnea P D light will flash Audible Alarm Tone Five pulses Display screen Test ERROR Refer to USER S MANUAL Cause Auser self test error condition exists if during the User Self Test the pressure in the patient circuit does not reach a sufficient level to perform the test Latching Status Latching Non Latching November 2003 6 7 Alarms and alerts Achieva Ventilator Clinician s Manual Leak Test Failure Alarm Visual Indicator Low Pressure Apnea P D light will flash Audible Ala
75. g alarms 6 5 Resources C 1 Respiratory failure B 3 Respiratory insufficienty B 3 Response time 5 7 Response to low power alarm 6 17 low pressure alarm 6 8 Achieva Ventilator Clinician s Manual November 2003 Achieva Ventilator Clinician s Manual power switchover alarm 6 16 S Safety check monthly 5 17 Self test 4 23 Sensitivity 3 7 5 3 B 3 Serial number label 3 13 Service information F 1 Setting error alarm response to 6 12 Setting error alarms 6 10 Settings specifications E 3 Setup 4 1 SIMV B 3 SIMV mode CPAP 5 12 pressure support 5 11 Single reminder beep 6 3 Single three second tone 6 3 Specifications E 1 E 8 Spontaneous B 3 Spontaneous mode CPAP 5 15 pressure support 5 13 Standard compliance E 8 Standby 3 5 B 3 Starting the ventilator 5 1 Steady audible alarm 6 3 Sterilization 8 1 Stopping the ventilator 5 2 Symbol definitions 1 5 Synchronous Intermittent Mandatory Ventilation B 3 T Test battery switch 3 4 Test user self 4 23 Testing the batteries 4 8 Theory of operation D 1 D 15 Tidal volume B 3 Time and date setting 5 23 Top label 3 12 Top panel 3 2 Trichloroethylene 8 1 Trigger pressure 5 23 Troubleshooting 7 1 Troubleshooting chart 7 1 U Unpacking the ventilator 4 1 User self test 4 23 B 3 November 2003 Index Index User self test error 6 7 V Valley alarm 6 6 Ventilate switch 3 5 Ventilating hours 5 22 Ventilation modes and apnea 5 16 Ventilator data A 1 Ventila
76. ging the ventilator or Caution losing data Directions that make it easier to use the ventilator Note Warning Anything that damages the ventilator may cause potential danger to the patient 1 4 November 2003 Achieva Ventilator Clinician s Manual Symbols and their definitions A 0123 eos EITEsT Menu Esc PEEP November 2003 Attention consult accompanying manual Alternating current Direct current Volts Amperes Standby mode of operation Type BF equipment degree of protection against electrical shock Alarm CE mark This device complies with the requirements of Directive 93 42 EEC concerning medical devices Drip proof External Battery power connector Alarm Silence Reset switch Test Battery switch Mode selection switch Menu Esc function selection switch Volume parameter setting switch Inspiratory Time parameter setting switch Breath Rate parameter setting switch Pressure Support parameter setting switch Positive End Expiratory Pressure parameter setting switch Introduction 1 5 Introduction 1 E Py Pt SENS 0 V 00 P4 PT AC t3 E amp AC SSIF 6 VE Ratio LCD indicator Low Pressure alarm setting switch High Pressure alarm setting switch Sensitivity parameter setting switch 10 oxygen parameter setting switch Flow LCD indicator Start Enter function setting switch Venti
77. have questions about the power line contact a qualified electrician or Puritan Bennett If you have questions about how the ventilator will operate contact Puritan Bennett Technical Support November 2003 Achieva Ventilator Clinician s Manual Warning Set up If you have doubts about the ground connection have a qualified electrician examine the outlets If necessary have them properly grounded When operating on AC power the ventilator will recharge the internal battery in any ventilation mode including Standby The internal battery will charge from the external battery only when the ventilator is operating not in standby AC power does not recharge the external battery when connected to the ventilator The external battery can be charged by a battery charger only External Battery 24 Volt DC Note Note November 2003 Whenever AC power is unavailable the ventilator can operate from an external 24 VDC battery Use a special cable from Puritan Bennett to connect the ventilator to the battery Use only Puritan Bennett approved batteries A power switchover alarm signals a change from AC to external battery or from external to internal battery Puritan Bennett recommends use of a 24 VDC external battery for optimal perfomance Although a 12 V battery can power the ventilator a Setting Error alarm is more likely to occur with the use of a 12 V battery under extremely heavy load Refer to Appendix E Specifications fo
78. hich is not an immediate danger to the patient but of which the operator should be aware Apnea During Assist Control ventilation an absence of breath delivery or inspiratory effort for 10 1 seconds During SIMV or Spontaneous ventilation Achieva PS and Achieva PSO an absence of breath delivery or inspiratory effort for 20 1 seconds Assist Control In Assist Control mode the ventilator delivers an assisted breath of a set volume or set pressure when the patient s breathing effort creates a flow that is greater than the Sensitivity setting optionally assisted breaths will be delivered when the patient s breathing effort reduces pressure in the patient circuit by the amount selected When the patient s breath rate falls below the breath rate setting the ventilator will deliver a controlled breath of the set volume or pressure Does not apply in Spontaneous mode Assist Spontaneous Assist Spontaneous LED indicates inspiratory effort sufficient to trigger delivery of a breath Caregiver An individual who assists a patient with the tasks of daily living This may be a family member a live in assistant or the nursing staff of a healthcare facility Caution Directions that warn of potential damage to the ventilator or of data loss Appendix B Achieva Ventilator Clinician s Manual Continuous Positive Airway Pressure CPAP Airway pressure maintained above ambient pressure Available in SIMV mode from all Achieva vent
79. ht will flash Audible Alarm Tone Five pulses that cannot be reset or silenced Display screen WARNING Battery charge depleted Cause The ventilator is powered from the internal battery and the internal battery s charge is depleted Latching Status Latching Responses to Battery Charge Depleted alarm Condition 1 Ventilator continues to operate Disconnect the ventilator from the patient To reset press the Standby cb switch for at least 3 seconds and then allow 30 seconds to pass without touching any controls The ventilator will switch to low power standby Connect an external power source and 6 18 elf the unit is connected to AC it will automatically exit the low power standby mode and begin to charge the internal battery Press the Ventilate 0 switch to resume ventilation elf the unit is connected to a charged external battery you must press the Start Enter switch to restart The internal battery will not begin to recharge until the ventilator is put into the ventilate mode November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Condition 2 All the indicator lights are illuminated and the ventilator no longer operates Disconnect the ventilator from the patient To reset press and hold the Standby switch for at least 3 seconds The unit will switch to the low power standby mode Connect an external power source and elf the unit is co
80. ient triggered breath The sensitivity parameter range is 3 to 25 LPM liters per minute in increments of 1 LPM The breath will be delivered to the patient when flow is within 0 5 LPM of the sensitivity setting To set flow sensitivity 1 If the settings are not displayed press Start Enter 4 1 The settings will appear on the display 2 Press the Sensitivity SENS switch The displayed setting will begin to flash 3 Use the up and down arrow keys to select the flow in liters per minute 4 When the prescribed value is displayed press the Start Enter switch to accept the setting November 2003 Achieva Ventilator Clinician s Manual Operation The pressure trigger can be set to OFF or 1 to 15hPa in increments of 1hPa below the baseline pressure When using PEEP set the Pressure Trigger along with the sensitivity setting Flow Trigger See Flow trigger on page 5 4 To set the pressure trigger level 1 Press the Menu ESC switch The display shows the first menu item 2 Use the up and down arrows to scroll to the message Press ENTER to change pressure trigger 3 Press the Start Enter 4 1 switch The display shows the message Trigger Level XXX UP DN change ENTER keep 4 Use the up and down arrow keys to select the prescribed pressure trigger level B Press Start Enter 4 to accept the setting November 2003 5 5 Operation Achieva Ventilator Clinician s Manual Alti
81. ilator models Available in Spontaneous mode from Achieva PS and Achieva PSO only Achieve CPAP by setting Pressure Support to O and PEEP to the prescribed level of CPAP Expiratory sensitivity The expiratory sensitivity level is a percentage of peak flow at which a pressure supported breath will be terminated The expiratory sensitivity level has settings of 15 to 55 in 10 increments Flow The average inspiratory air flow calculated as V t Flow acceleration The inspiratory Flow Acceleration feature controls flow during pressure supported and pressure controlled breaths When the flow acceleration feature is ON the actual flow rate during inspiratory phase of a pressure supported or a pressure controlled breath cannot exceed 180 LPM Modem modulator demodulator Device for converting binary signals into tones that can be transmitted over telephone lines Note Directions that make it easier to use the ventilator Nurse call output Connector on the ventilator for use with call systems in use at many healthcare facilities Connected to a relay that switches during alarm conditions See Connecting to a nurse call system on page 4 20 0 Fail The Fail alarm will sound after 10 breaths if the ventilator does not detect a flow source at the oxygen inlet Positive End Expiratory Pressure PEEP Pressure in the patient circuit at the end of expiration above ambient Presilence Pressing the Alarm Silence Reset 67 sos sw
82. ilator on AC power to recharge the internal battery approximately 45 minutes of power under normal load conditions A fully depleted internal battery will be fully charged in 12 hours Fail STEADY SOUND O2 source has failed Supply another oxygen source Monitor delivered oxygen Attempt to reset by disconnecting from power then reconnecting to power ZNWARNING If alarms continue to sound provide another means of ventilation This label cautions you not to block the opening for the audible alarm Blocking the opening may prevent you from hearing the alarm CAUTION ALARM OUTPUT DO NOT BLOCK 1 Agency symbols label This label on the back of the ventilator gives regulatory certification information concerning your ventilator NELLCOR Puritan Bennett Minneapolis Minnesota USA PASSIF UL TYPE BF MEDICAL EQUIPMENT 0123 CAN CSA C222 EQUIPMENT CLASSIFIED No 601 1 M90 UL2601 1 LR 59730 7P73 November 2003 3 13 Description Achieva Ventilator Clinician s Manual Back panel label The following information is printed on the back of your ventilator ZN WARNING FOR CONTINUED PROTECTION AGAINST FIRE USE ONLY THE SAME TYPE AND RATING OF FUSE 250V 3 15A SLOW BLOW ZN AVERTISSEMENT POUR UNE PROTECTION CONTINUE CONTRE LES RISQUES D INCENDIE TOUJOURS UTILISER DES FUSIBLES DE MEME TYPE ET DE MEME AMPERAGE SOIT 250 V CA
83. instructions for unpacking and setting up Achieva ventilators This chapter includes a visual inspection and user self test for the ventilator Instructions for setting the low pressure alarm are included Unpacking To unpack your ventilator follow the directions on the package The information presented here is for your convenience 1 Remove the manuals and other material from the top of the pack age 2 Pull the ventilator out of the box using the handles on the insert 3 Remove the ventilator from the insert and from the plastic bag Save all packaging material Always ship the ventilator in the supplied packaging material If you need replacements for your packaging contact Puritan Bennett November 2003 4 1 Set up Note 4 2 4 Achieva Ventilator Clinician s Manual When you first get your ventilator you should perform a visual inspection of the device Make sure that The power cord does not have any kinks breaks or damaged insulation The connectors rubber feet filter housings etc are not loose or broken The outer casing has no dents or scratches which may indicate dropping or other abuse eAll the labels and markings on the ventilator are clear and legible If the ventilator does not pass the visual inspection contact your equipment supplier or Puritan Bennett Technical Support at 1 800 255 6774 This visual inspection should be performed each time the ventila tor is used after sto
84. interactions between the ventilator and the patient that are not serious enough to constitute a direct risk but which the operator should be aware of They are signaled by a visual indicator and no audible alarm The alarm volume can be set louder or softer to one of two levels Contact Puritan Bennett s Technical Support at 800 255 6774 for instructions on making the necessary changes All alarms indicate a potential risk to patient safety When an alarm sounds provide immediate attention care and support to the patient as dictated by the situation Pressing Alarm Silence Reset prevents any audible alarm from sounding for 60 seconds even if new alarms occur during that time If an alarm condition occurs while the 60 second presilence period is in effect or while Alarm Silence Reset is active the LCD will display the alarm condition 6 1 Alarms and alerts Warning 6 2 Achieva Ventilator Clinician s Manual Any device is subject to unpredictable failures To ensure patient safety an appropriately trained caregiver should monitor ventilation If the patient s condition warrants the use of an independent secondary alarm or another external monitoring device the physician should prescribe it The physician should also determine to what level the patient may require an alternate means of ventilation in the event of ventilator failure November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts Alarm s
85. itch while no alarm conditions exist and no alarm LEDs are lit Prevents the audible alarm from sounding for 60 seconds Useful for routine procedures that would otherwise cause an alarm Pressure Control Augmentation of the patient s ventilation synchronously with inspiratory effort until a preset pressure is met Pressure is maintained throughout patient inspiratory flow and is cycled to expiration by time controlled by the selected Inspiratory Time setting Used in Assist Control mode by setting Pressure above 0 November 2003 Achieva Ventilator Clinician s Manual Warning November 2003 Appendix B Pressure Support Augmentation of the patient s ventilation synchronously with inspiratory effort until a preset pressure is met Pressure is maintained until inspiratory flow is reduced to a percentage of peak flow between 15 and 55 that depends on the expiratory sensitivity setting for the inspiration when the ventilator cycles into exhalation Available in SIMY or Spontaneous modes Achieva PS and Achieva PSO only Respiratory Failure The inability of a patient to spontaneously ventilate at a level that maintains normal respiration for any period of time Respiratory Insufficiency The inability of a patient to spontaneously ventilate at a level that maintains normal respiration for some time period usually less than 12 hours leading to negative effects over a prolonged period Sensitivity Level at which the ventilator
86. late function setting switch Low Pressure Apnea LED alarm indicator High Pressure LED alarm indicator Setting Error LED alarm indicator Power Switchover LED alarm indicator Low Power LED alarm indicator 0 Fail LED alarm indicator AC alternating current LED power source indicator External Battery LED power source indicator Internal Battery LED power source indicator Alarm Control LED indicator Battery Charging LED indicator Assist Spontaneous LED indicator Keep dry Achieva Ventilator Clinician s Manual UL Mark Classified by Underwriters Laboratories Inc with respect to electric shock fire and mechanical hazards only in accordance with UL2601 1 November 2003 Achieva Ventilator Clinician s Manual Introduction CSA Mark Certified by Canadian Standards Association to meet CAN CSA 22 2 No 601 1 M90 Fragile Year of manufacture A Fuse rating and type T3 15A 250V N Serial number November 2003 1 7 Introduction Achieva Ventilator Clinician s Manual 1 8 November 2003 Achieva Ventilator Clinician s Manual November 2003 Overview Chapter 2 Overview This chapter is an overview and comparison of Achieva ventilators This chapter includes general warnings and cautions and information on what to do if the ventilator fails to operate properly Puritan Bennett Achieva ventilators provide continuous respiratory support for pediatric to adult patients with respiratory
87. less than 5kg 11 lbs This device is for use in home institutional and portable settings Contra indications Achieva ventilators are not intended for the delivery of anesthetic gases Do not use or store in the presence of strong electromagnetic fields such as those surrounding MRI equipment November 2003 3 1 Description Achieva Ventilator Clinician s Manual lenuyEsc lt B Controls and display Door label D Patient pressure port E Patient air port Exhalation valve port G Patient pressure meter Top panel A O uuncxropr Cc D ALARM ALERT LIGHTS The ventilator s lights will flash when an alarm condition is 3 2 November 2003 Achieva Ventilator Clinician s Manual Note November 2003 Description detected The lights are turned off when the alarm condition is corrected and the Alarm Silence Reset eos switch is pressed See Chapter 6 Alarms and alerts for more details Achieva ventilators are equipped with the following alarm lights Low Pressure Apnea P High Pressure P f Setting Error Power Switchover ACA 6 Low Power 4 O Fail Only on Achieva PSO For the Achieva and Achieva PS models which do not have the oxygen function the O alarm light position is present but it has no light B POWER LIGHTS The power
88. lter is disposable do not attempt to wash or oth erwise clean it 1 Twist off the retainer ring of che Inlet Filter Flatpak from the back panel of the ventilator and replace the Flatpak filter cartridge 2 Ifyou are replacing a Model Y 6106 Inlet Filter keep the existing O ring for use with the Flatpak filter You may discard the exist ing screens and filter cap 3 Reassemble the O ring Flatpak filter and Retainer Ring as shown Inlet Housing Flatpak Filter Model Y 6109 Retainer Ring 2 Model Y 6109 ACH 8 2 November 2003 Achieva Ventilator Clinician s Manual Caution Caution Note November 2003 Maintenance Failure to change a dirty filter may cause serious damage to the ventilator A blocked inlet filter may cause a setting error alarm Do not operate the ventilator without an inlet air filter Using the ventilator without a filter may damage the ventilator Use only filters supplied by Puritan Bennett Do not reuse filters Discard them after removal 8 3 Maintenance Achieva Ventilator Clinician s Manual Changing the fuse A fuse may need to be replaced if the ventilator is plugged into an electrical outlet but the charging light is not illuminated The fuses for the ventilator are rated at 250 V 3 15 A 5 x 20 mm slow blow Replacement fuses are available from your equipment supplier or Puritan Bennett Caution For continued protection against fire hazard replace
89. nal 0 Blender No No Yes Access to Stored Events with the Achieva Yes Yes Yes Report Generator Software Pediatric Capability Yes Yes Yes Internal Battery Yes Yes Yes External Battery Capability Yes Yes Yes Portability Yes Yes Yes Caution properly Your ventilator is an electronic instrument Any electronic instrument may create and is subject to electrical interference Electrical interference in excess of 20 V m may keep your ventilator from working November 2003 Achieva Ventilator Clinician s Manual Note Overview If television interference does occur contact Technical Services at Puritan Bennett or a television repair technician for suggestions Or move the television to an electrical outlet that does not allow interference If another device interferes with your ventilator Television sets cordless or cellular telephones microwave ovens air conditioners food processors and other appliances can be sources of electrical interference To avoid electrical interference between your ventilator and these appliances follow these instructions Do not place your ventilator near the appliances Do not plug the ventilator into the same AC electrical outlet nor into the electrical outlets on the same circuit as the appliances not place the ventilator cables near the appliances If your ventilator causes interference in another device If the ventilator causes interference to other devices
90. nce Reset ij 60 s switch to reset the Low Pressure Apnea alarm Verifying Alarm Functions 5 18 Before using the ventilator complete the following procedures to test the function of the various alarms on Achieva ventilators Unless stated otherwise the initial ventilator settings for these tests are Breath rate 12 BPM High Pressure 80 hPa Low Pressure 3 hPa Volume 500 ml Inspiratory Time 1 0 seconds FIO2 21 percent Ventilation Mode Assist Control November 2003 Achieva Ventilator Clinician s Manual Operation Low Pressure 1 With the ventilator in Assist Control mode adjust the Volume setting to 500ml Inspiratory Time to 0 4 seconds and the Low Pressure alarm to 5 hPa 2 Attach an approved breathing circuit to the output port of the ventilator 3 With the patient end of the breathing circuit open to the atmo sphere allow the ventilator to deliver three consecutive breaths At the beginning of inspiration of the third breath check that ethe LED for the Low Pressure alarm lights up ethe LCD display indicates that a Low Pressure alarm has occurred ethe audible alarm sounds 4 Place the ventilator back in Standby mode by pressing and holding the Standby button for three seconds Reset the alarm Apnea 1 With the ventilator in Standby mode adjust the Volume setting to 500ml Inspiratory Time to 0 5 seconds and the Breath Rate to 5 BPM 2 Place the ventilator in Assist Control mode
91. nd information regarding connection of the ventilator s modem Achieva PS and Achieva PSO only to the telephone lines Power Line 100 to 240 VAC 50 to 60 Hz 2 Amps External DC Power 11 6 to 32 0 VDC 24 VDC optimal Operating time At least 19 hours under normal load and 5 hours 30 minutes under heavy load 24 VDC or 12 VDC 32 Ah Amp Hour Internal Battery 24 VDC nominal Operating time At least 4 hours under normal load and 1 0 hour under heavy load Gel cell sealed Lead Acid Lithium Battery Standard Power Converters 90 to 200 VAC Fuses 2501 3 154 5X20 mm slow blow Power Usage Maximum 75W Minimum 10W Type Positive Pressure Volume ventilator Motor 3 phase brushless motor Pump Piston 50ml to 2200ml tidal volume capability Protection against electrical shock Type of protection Class 1 Degree of protection Type BF Normal Load Mode Assist Control Volume 1000 ml Breath Rate 10 BPM Inspiratory Time 1 5 sec F0 21 Sensitivity 5 LPM PEEP 0 hPa Vent pres 30 hPa Heavy Load Mode Assist Control Volume 1500 ml Breath Rate 20 BPM Inspiratory Time 1 0 sec F0 100 Sensitivity 5 LPM PEEP 20 hPa Vent pres 60 hPa November 2003 Appendix E Achieva Ventilator Clinician s Manual Indicators Normal Events Patient Pressure Meter Displays patient pressure 10 to 100
92. nformation on what to do if the ventilator fails to operate properly Description This chapter gives the intended uses and contra indications for Achieva ventilators It describes the features controls and labels on the ventilator Some of the accessories used with Achieva ventilators are also described Setup This chapter has instructions for unpacking and setting up the Achieva ventilators It includes a visual inspection and user verification test Instructions for setting the Low Pressure alarm are also included Operation This chapter contains information on starting and stopping the ventilator as well as instructions for setting the various modes and menu selections It includes a monthly safety check and a list of the information the patient and caregiver must know to use the ventilator safely and effectively Alarms Instructions on responding to ventilator alarms A list of all ventilator alarms is included Troubleshooting This chapter discusses basic troubleshooting for the Achieva ventilators Maintenance This chapter has cleaning and maintenance information for the ventilator and a maintenance schedule Ventilator data This chapter tells how to print a report from the ventilator and describes the information in that report It also describes how to transfer information from the ventilator to a computer equipped with Achieva Report Generator software from Puritan Bennett Glossary This appendix presents the definitions
93. ng Spontaneous mode the alphanumeric display will show the option to enter backup rate Use the up and down arrows to select Y or N The pressure setting during the spontaneous back up mode is equal to the Pressure Support setting before the apnea condition began and the I E ratio is 1 2 If the patient initiates a spontaneous breath while the back up rate option is in effect the ventilator will return to the previous operating parameters If the back up rate option is not chosen the ventilator will sound an apnea alarm if no breath is triggered by the patient in 20 seconds 5 16 November 2003 Achieva Ventilator Clinician s Manual Operation Monthly safety check Perform this check at least monthly while the ventilator is in use Warning Throughout this check the ventilator must be disconnected from the patient Provide another means of ventilation 3 November 2003 Perform a visual inspection of the device Make sure that The power cord does not have any kinks breaks or damaged insulation The connectors rubber feet filter housings etc are not loose or broken The outer casing has no dents or scratches which may indicate dropping or other abuse All the labels and markings on the ventilator are clear and legible This visual inspection should be performed each time the ventila tor is used after storage as well as periodically during normal use If the ventilator does not pass the inspection pr
94. nnected to AC it will automatically exit low power standby mode and begin to charge the internal battery Press Ventilate a to resume ventilation elf the unit is connected to a charged external battery you must press the Start Enter switch to restart The internal battery will not begin to recharge until the ventilator is put into the ventilate mode November 2003 6 19 Alarms and alerts Achieva Ventilator Clinician s Manual 6 20 November 2003 Achieva Ventilator Clinician s Manual Troubleshooting Chapter 7 Troubleshooting This chapter provides basic troubleshooting of Achieva ventilators Troubleshooting chart When there is a problem with the ventilator or its accessories you must first check to make sure the patient is not in danger If necessary provide an alternate means of ventilation When the patient is out of danger proceed with your inspection of the ventilator and equipment If the cause of the problem cannot be determined contact your equipment supplier or Puritan Bennett Do not use the ventilator and equipment until the problem has been corrected Conditions Display Message Probable Cause Solution All lights turn on and audible No display message Normal condition Alarms test Alarms will stop in two seconds alarm sounds when the unit is turned on Normal manual alarm test Alarms will stop in one second Microprocessor error Disconnect the ventilator from external power Press
95. nt is highly susceptible to respiratory infections Dirty or contaminated equipment may be a source of infection Clean equipment is essential for successful ventilation Be sure to wash your hands thoroughly before and after contact with the patient circuit The following message will display Press ENTER when ready to begin test B When you have a good seal on the Exhalation Manifold press the Start Enter 41 key November 2003 4 23 Set up 4 24 7 Achieva Ventilator Clinician s Manual The ventilator will push air into the circuit as it runs the test Tf the ventilator passes the test the following message will display TEST PASSED ENTER repeat ESC exit Press the Start Enter 2 switch if you wish to repeat the test or the Menu ESC switch to end the test and place the ventila tor into Standby Tf the ventilator fails the test one of three messages will be dis played Test ERROR Refer to MANUAL If this message is displayed it means the test was not conducted properly e Press the ALARM SILENCE RESET switch The display screen will indicate that the test was a failure Test FAILED ENTER repeat ESC exit e Check all the connections in the patient circuit including the blockage in the exhalation manifold e Press START ENTER to repeat the test Leak Test FAILED Refer to MANUAL e If this message is displayed it means that there is a leak in the patient circuit somewhere b
96. ntains instructions for maintaining and cleaning the ventilator You must also consult the corresponding cleaning instructions for the various accessories used with the ventilator A ventilator patient is highly susceptible to respiratory infections Dirty or contaminated equipment may be a source of infection Clean equipment is essential for successful ventilation Be sure to wash your hands thoroughly before and after cleaning the ventilator or accessories Do not sterilize the ventilator with ethylene oxide ETO or steam Doing so may damage the ventilator Do not use MEK trichloroethylene or alcohol to clean the ventilator Their use may damage the unit s surfaces 8 1 Maintenance Achieva Ventilator Clinician s Manual Ventilator surface Clean as often as the surface becomes soiled 1 Clean with a mild soap solution and a damp cloth Squeeze the cloth thoroughly before applying it to the unit s surface 2 Do not allow liquids to enter the ventilator Warning Never allow liquids to contact internal ventilator components under any circumstances Excessive moisture will damage the ventilator Note Contact Puritan Bennett for alternate cleaning methods Flatpak filter The model Y 6109 Inlet Filter Flatpak is a standard part for the ventila tor Inspect the filter monthly weekly if used outdoors portably or in a dusty atmosphere Replace with a new filter when it shows signs of dis coloration The Flatpak fi
97. o these components a Low Pressure Apnea P 4 alarm may not sound See Setting the low pressure alarm on page 4 26 High Pressure Pt The High Pressure P 1 section of the display shows the highest pressure the ventilator will allow without sounding the High Pressure alarm Pressing the High Pressure P 1 switch causes the current high pressure limit setting to flash and allows it to be changed VE Ratio The I E Ratio 1 E display shows the ratio of inspiratory to expira tory time Achieva ventilators permit a range of inspiratory times from 0 2 seconds to 5 0 seconds The I E ratio is calculated according to the formula Ratio 1 Breath Rate Inspiratory Time Inspiratory Time November 2003 Achieva Ventilator Clinician s Manual Description FjO 0 Only on Achieva PSO The FjO5 0 display shows the set enriched oxygen level Pressing the F O 0 90 switch causes the current setting to flash and allows it to be changed A setting of over 21 will activate the internal O blender Note For the Achieva and Achieva PS models that do not have the oxygen func tion the F O switch is present but it has no label and is inoperative November 2003 3 9 Description Achieva Ventilator Clinician s Manual Back and sides 3 10 2030046 130550 VAP Som A WARNING dis CONTINUED PROTECTION AGAINST MTI AND RING OF FUSE A C TSEM
98. of terms used in this manual Resources brief bibliography and a list of organizations of interest to clinicians caregivers and patients November 2003 Achieva Ventilator Clinician s Manual November 2003 Introduction Theory of operation Operating theory for Achieva ventilators It includes a description of the modes and sample waveforms Specifications Complete technical specifications for Achieva ventilators Service Information on obtaining service for the ventilator including the limited warranty Index An alphabetical list of the topics covered in this manual 1 3 Introduction Achieva Ventilator Clinician s Manual Additional information Conventions For additional information about Achieva ventilators read the Achieva Ventilators User s Manual and the Achieva Ventilators Technical Manual For information on the Achieva Report Generator see the Achieva Report Generator User s Guide and the Report Generator software s on line help file Puritan Bennett publishes newsletters conducts seminars and supports organizations of interest to clinicians and patients For more information on these sources contact Puritan Bennett at 1 800 635 5267 or www puritanbennett com Throughout this manual Warnings Cautions and Notes mean the following Directions that warn of conditions that put the patient Warning caregiver or other individuals at risk of injury Directions that help you avoid dama
99. on Achieva PSO Connect the optional internal O blender to an oxygen source with a standard oxygen connection hose Screw the hose fitting tightly onto the oxygen input connection The hose fitting must be compatible with a 9 16 18 DISS 1240 male connector For the Achieva and Achieva PS models there is a label but no connector NIST adapter kits are available Flow is measured at the output port of the ventilator These measurements must be corrected for altitude using the Altitude setting and have an accuracy of 2 LPM at nominal barometric pressures Pressure measure ments are taken at the patient end of the breathing circuit Pressure mea surements are relative to the current atmospheric pressure and have an accuracy of 2 5 hPa 3 11 Description Top label 3 12 INTENDED USE This device is intended to provide ventilatory support for pediatric Patients should weigh no less than 11 Ibs 5kg and adult patients who require positive pressure mechanical ventilation This device is for use in home institutional and portable settings A DANGER EXPLOSION HAZARD DO NOT USE IN THE PRESENCE OF FLAMMABLE ANESTHETICS A DANGER RISQUE D EXPLOSION NE PAS EMPLOYER EN PRESENCE D ANESTHESIQUES INFLAMMABLES ZA CAUTION Electrical shock hazard Do not remove cover Refer servicing to qualified personnel Removal of panels voids warranty Mallinckrodt will not be held responsible for performance Achieva Ventilator Clinician
100. on procedures and instructions to assist in the repair of parts classified by Puritan Bennett as repairable Before returning any device to Puritan Bennett you must get a Return Authorization Number F 1 Appendix F Achieva Ventilator Clinician s Manual Limited warranty Puritan Bennett warrants to the owner that the Achieva ventilator exclusive of expendable parts and other accessories shall be free from defects in material and workmanship for twelve months from the original date of sale Puritan Bennett s sole obligation with respect to any such defect is limited to the repair or at Puritan Bennett s option replacement of the ventilator Purchaser pays return freight charges This warranty is made on the condition that prompt notification of a defect is given to Puritan Bennett within the warranty period and that Puritan Bennett has the sole right to determine whether a defect exists This warranty is conditional on the performance of Preventive Maintenance at a minimum of once every 6000 operating hours or recertification every twelve 12 months whichever occurs first by service personnel qualified by Puritan Bennett The warranty does not apply to ventilators that have been partially or completely disassembled altered subjected to misuse negligence or accident or operated other than in accordance with the instructions provided by Puritan Bennett This includes repair by unauthorized personnel This warranty repre
101. open while the pressure was above the relief valve threshold pressure Latching Status Non Latching Response to a High Pressure Alarm 1 Attend to patient first 2 Check the patient circuit for kinks Fix or replace the patient circuit 1 Attend to patient first 2 Check to see if the ventilator s settings are correct Correct any setting errors 4 If the ventilator s settings are set according to a doctor s prescrip tion contact your doctor or equipment supplier November 2003 6 9 Alarms and alerts Achieva Ventilator Clinician s Manual Setting Error Alarms Invalid I E Ratio Alarm Visual Indicator The Setting Error light will flash Audible Alarm Tone Three pulses Display screen WARNING Invalid ratio Check settings Cause A combination of setting breath rate and inspiratory time resulting in an inspiratory time that exceeds the expiratory time Latching Status Non Latching High Pres lt Low Pres Alarm Visual Indicator The Setting Error light will flash Audible Alarm Tone Three pulses Display screen SETTING ERROR High Pressure lt Low Pressure setting Cause The low pressure limit setting is the same or higher than the high pressure setting Latching Status Non Latching Volume Error Alarm Visual Indicator The Setting Error light will flash Audible Alarm Tone Three pulses
102. ory phase of a pressure supported or a pressure controlled breath cannot exceed 180 LPM The operator can also set the expiratory sensitivity level which is a percentage of peak flow at which a pressure supported breath will be terminated The expiratory sensitivity level has settings of 15 to 55 in 10 increments See the waveforms on the opposite page Appendix D Achieva Ventilator Clinician s Manual Start of inspiration off End of inspiration V l y l Variable l Time D 8 November 2003 Achieva Ventilator Clinician s Manual Mandatory volume breaths in SIMV mode November 2003 Appendix D In Synchronized Intermittent Mandatory Ventilation SIMV the mandatory volume breaths deliver the selected Volume over the selected Inspiratory Time Inspiration is triggered by patient generated flow or pressure drop for assisted breaths or by the ventilator for controlled breaths Breath Rate is the controlling parameter For both controlled and assisted breaths the inspiration is limited by the volume and is cycled by volume and time See the waveforms on the following page SIMV mode will also deliver pressure supported breaths For a description of pressure supported breaths see page D 13 For a discussion of how mandatory volume and pressure supported breaths interact in SIMV mode see page D 12 D 9 Appendix D Achieva Ventilator Clinician s M
103. ounds Following is a list of the alarm sounds and alerts generated by Achieva ventilators Repeating burst of five pulses e Low pressure apnea e Battery charge depleted e Vent Inop Repeating burst of three pulses e Extremely low internal battery e High pressure e Setting error e O fail Single reminder beep Low internal battery beep is repeated every five minutes e Minor fault condition beep is repeated every 30 minutes e Serious fault condition beep is repeated every 15 minutes detected during a ventilating mode Single three second tone Serious fault condition detected while ventilator is not in a ventilating mode Steady audible alarm e Microprocessor failure Repeated single beep e Power switchover Visual indicator with no audible alarm alert status e Volume setting error e Inspiratory setting error Alert messages are only visible if no alarms are present Warning If alarms continue to sound provide another means of ventilation November 2003 6 3 Alarms and alerts Achieva Ventilator Clinician s Manual Latching and non latching Some of the ventilator s alarms those that cause the low pressure LED to flash have the option of operating in either a latching or non latching mode e Inthe non latching mode the audible alarm will be silenced as soon as the condition that caused the alarm is corrected Some alarm conditions correct themselves e In the latching mode the audible alarm
104. ovide an alternate means of ventilation and contact your equipment supplier or Puri tan Bennett Technical Support Perform a user self test See User self test on page 4 24 Test the audible alarm and the indicator lights Press and hold the Alarm Silence Reset 8 60 5 switch while an alarm condition does not exist for at least five seconds The audible alarm must sound and all the ventilator s indicator lights must light Connect a patient circuit to the ventilator Connect the ventilator to AC power 5 17 Operation Warning Achieva Ventilator Clinician s Manual Set the ventilator mode to Assist Control A C Press Ventilate 0 Block the end of the patient circuit It is important that you make a tight seal and do not let any air escape A ventilator patient is highly susceptible to respiratory infections Dirty or infected equipment may be a source of infection Clean equipment is essential for successful ventilation Be sure to wash your hands thoroughly before and after contact with the patient circuit 7 At the next attempt to deliver a breath a high pressure alarm must occur Unblock the end of the patient circuit Press Alarm Silence R eset 67 60 5 reset the high pressure alarm A Low pressure Apnea alarm must occur after two or three breath cycles Press and hold for at least three seconds the Standby switch to put the ventilator in Standby mode Press the Alarm Sile
105. ow sensor Range 01P 0180 LPM Temperature Range 25 C to 85 C Accuracy 3 5 of reading over 5 C to 60 C Condition Nominal barometric pressure Changes in gas density due to changes in altitude are compensated for via the Altitude setting Primary Flow Purpose Measures the amount of gas discharged from the ventilator s output port Location Patient output port Type Mass flow sensor Range 0 LPMto 180 LPM Temperature Range 25 C to 85 C Accuracy 3 5 of reading over 5 C to 60 C Condition Nominal barometric pressure Changes in gas density due to changes in altitude are compensated for via the Altitude setting Relative Motor Position Purpose Senses the relative motion of the piston drive motor Location Stator of motor Type Hall sensor Range Digital November 2003 Achieva Ventilator Clinician s Manual Appendix E Accuracy NA Environment Operating 5 Cto 40 C 41 F to 104 F 10 to 90 RH Storage 20 Cto 50 C 4 F to 140 F 10 to 90 RH When moving the ventilator from a non operating to an operating environment allow a minimum of one hour temperature stabilization before use When storing the ventilator the battery must be recharged every thirty days Storage above or below specified operating temperatures may affect battery life November 2003 Appendix E
106. printer output See Printing reports from the ventilator on page A 1 Alarm Silence Reset 67 60 s The Alarm Silence Reset 67 605 switch silences the audible alarm during an alarm condition The Alarm Silence Reset 67 60 5 switch can used to presilence the audible alarm for a period of 60 seconds Ifan alarm condition occurs while the 60 sec ond presilence period is in effect or while Alarm Silence Reset is active the LCD will display the alarm condition This switch can also be used to reset an alarm after the alarm condition has been cor rected November 2003 Achieva Ventilator Clinician s Manual Description Controls and display Menu Esc CL 1 4L LL ILL gt Ventilator Ventilation mode and dl dl controls parameter controls c l j Alphanumeri SIMV 1000 1 5 60 display 15 20 20 10 60 1 1 7 98 Ventilation mode and C JC JC JC JI parameter controls f J PEEP Pt 0 LJ LA The control display panel consists of an alphanumeric display showing the set or current actual values of operating parameters and ventilator information e push button switches that the operator uses to make s
107. r normal and heavy load conditions If you are using a 12 V battery run the ventilator at the intended settings before connecting it to the patient to make sure the ventilator is able to function fully at the selected settings As the battery discharges a setting alarm is more likely to occur Carefully connect the 24 VDC battery to the ventilator Follow the battery manufacturer s instructions Use only Puritan Bennett s cables Check to see if the ventilator s External Battery 17 light is lit This light signals that your ventilator is properly connected and is using the external battery Do not reverse the positive and negative cables when connecting a battery to your ventilator If you accidentally reverse the connections a protective fuse may open in the battery box or in the ventilator With the resulting open circuit the external battery will not provide power to the ventilator You must first correct the connections and install a correct replacement fuse in the system Only then will the external battery power the ventila tor Set up Note Note Achieva Ventilator Clinician s Manual Always keep a spare fuse with your battery and cable Contact your equip ment supplier or Puritan Bennett Batteries and connecting cables are available from Puritan Bennett These accessories come with instructions for connection and use The battery and case provided by Puritan Bennett have a cable with a three pin connector When
108. rage as well as periodically during normal use Tf the ventilator does not pass the inspection provide an alternate means of ventilation and contact your equipment supplier or Puri tan Bennett Technical Support Wipe the ventilator with a mild soap solution if necessary Make sure that a new air filter has been installed See Flatpak filter on page 8 3 Plug in the ventilator to a functioning grounded electrical outlet During storage the internal battery may lose its electrical charge Leave the ventilator plugged in for a minimum of twelve hours to recharge the bat tery fully The ventilator will activate the audible alarm and all the visual alarms for a period of one or two seconds Verify that all the visual alarm indicators light up and the audible alarm makes a tone If not the ventilator is in need of repair Do not use the ventilator until the problem has been corrected Turn the ventilator on See Starting the ventilator on page 5 1 November 2003 Achieva Ventilator Clinician s Manual Set up 7 Follow the steps for the self test See User self test on page 4 23 If the ventilator does not pass the self test contact your equipment supplier or Puritan Bennett Technical Support If the ventilator passes the self test set the ventilator s parameters according to the prescription See Operating the controls on page 4 21 Accessory checklist Achieva ventilators need the following items to function properly
109. ratory time Set the inspiratory sensitivity to an appropriate level Set the breath rate Set Pressure to 0 Set PEEP as required Set the low pressure and high pressure alarm levels See Setting the low pressure alarm on page 4 27 If required set F O available only on Achieva PSO Press Ventilate am to begin breath delivery 5 7 Operation Achieva Ventilator Clinician s Manual Limiting inspiratory flow Flow Acceleration Warning 5 8 When using pressure control in modes with pressure supported and pressure controlled breaths you can set the ventilator to limit the inspiratory flow rate The flow acceleration can be turned on or off When flow acceleration is off the ventilator delivers maximum flow with relatively little pressure integration When on the flow is metered to 180 lpm maximum The clinician must be aware that limiting flow below the patient s inspiratory demand will limit airway pressure and may prevent adequate ventilation Close monitoring of patient parameters is essential to ensure that the patient is adequately ventilated To set inspiratory flow limitation 1 Press che MENU ESC key 2 Press the up or down arrow keys until the display shows the message Press ENTER to change flow acceleration Press the START ENTER key The display shows the current setting Flow acceleration OFF UP DN change ENTER keep 4 Use the up and down arrow keys to enable ON or disable
110. rm Tone Five pulses Display screen Leak test FAILED Refer to USER S MANUAL Cause A leak test failure alarm condition exists when the patient circuit does not maintain the appropri ate pressure or the exhalation valve fails to open and reduce the pressure in the patient circuit Latching Status Latching Non Latching Response to Low Pressure Alarms 1 Attend to the patient first 2 Check the patient circuit for kinks or loose connections Fix or replace the patient circuit If the alarm is not corrected 1 Attend to patient first 2 Check to see if the ventilator s settings are correct Correct any setting errors 4 Ifthe ventilator s settings are set according to a doctor s prescrip tion contact your doctor or equipment supplier 6 8 November 2003 Achieva Ventilator Clinician s Manual Alarms and alerts High Pressure Alarms High Pressure Alarm Visual Indicator High Pressure Pt light will flash Audible Alarm Tone Three pulses Display screen WARNING High Pressure Alarm Attend to patient Cause The pressure in the patient circuit exceeds the high pressure limit setting Latching Status Non Latching Relief Valve Test Failure Visual Indicator High Pressure P 1 light will flash Audible Alarm Tone Three pulses Display screen Relief valve test FAILED Refer to USER S MANUAL Cause The relief valve failed to
111. rnal battery immediately after use Use a Puritan Bennett approved battery charger The time required to recharge a battery varies With a Puritan Bennett charger a fully depleted external battery will be fully charged in twelve hours Every four to six weeks run the ventilator on the external battery until the ventilator switches to the internal battery Immediately disconnect the external battery switch to AC power and recharge the external battery until it is fully charged Caution Recharge an external battery immediately after use You should use a Puritan Bennett approved battery charger to recharge external batteries Caution There is a possibility of reduced performance when the ventilator is powered by a 12 VDC battery In this event you will get a Setting Error alarm Volume November 2003 4 7 Set up Caution Caution Achieva Ventilator Clinician s Manual Error Rate Error or Inspiratory Error alarm When recharging the external battery first connect the battery to the charger then connect the charger to AC power Never connect a battery charger to an external battery while the battery is connected to the ventilator This may cause permanent damage to the ventilator With a 24 or 12 volt battery the ventilator can operate for at least 19 hours with NORMAL LOAD operating parameters See Appendix E Specifications for more details There is a possibility of reduced performance with a 12 volt battery Testing
112. ropriate fitting on both the ventilator and the proximal pressure port 4 Place the ventilator in Assist Control mode by pressing and hold ing the ventilate button for 1 second while the parameter settings are showing on the LCD display Occlude the exhalation port of the breathing circuit s exhalation valve B Allow the ventilator to deliver four consecutive breaths At the beginning of the fourth breath check that ethe LED for the Low Pressure alarm lights up ethe LCD display indicates that a Valley alarm has occurred ethe audible alarm sounds 6 Remove the occlusion and set the ventilator to Standby mode by pressing and holding the Standby button for 3 seconds Reset the alarm Inspiratory Time Low Volume 1 With the ventilator in Standby mode adjust the Volume setting to 500ml Inspiratory Time to 0 4 seconds and Low Pressure alarm to 50 hPa 2 Attach an approved breathing circuit to the output port of the ventilator make sure that the pressure tube of the breathing cir cuit is connected to the appropriate fitting on both the ventilator and the proximal pressure port 3 Place the ventilator in Assist Control mode by pressing and hold ing the ventilate button for 1 second while the parameter settings are showing on the LCD display November 2003 5 21 Operation Warning Achieva Ventilator Clinician s Manual Keep the patient end of the breathing circuit open to the atmo sphere and allow the ventil
113. rs greater than 15 hPa averaged over a 100 millisecond period will result in a ventilator fault alarm The high pressure relief valve limits the pressure delivered to the patient to a maximum of 90 hPa 10 hPa The internal oxygen blender available only on Achieva is shown in the solid line on the pneumatic diagram Oxygen 138 552 kPa 20 80 PSIG enters the blender through the DISS O connector and passes through the blender c v check valve and the mesh filter 40 micron The regulator drops the pressure to 400 kPa 55 PSIG before feeding the oxygen to two parallel VSO O valves The oxygen flow supplying the pump is controlled from 0 to 100 capacity by varying the voltage sensitive orifices VSOs from fully closed to fully opened Oxygen concentrations available to the patient are reduced by low pressure supplied to the blender and high volume of total gases delivered to the patient The flow sensor measures the oxygen volume delivered to the pump This is compared to the total volume to determine the percentage of oxygen concentration delivered to the patient At low flow rates total gas flow is calculated based on tidal volume When the ventilator determines that the measured flow rates are insufficient for the 0296 setting the O5 FAIL 5 alarm will sound D 3 Appendix D Achieva Ventilator Clinician s Manual Breaths and ventilation modes Breaths available from the ventilator are e Volume breaths in
114. s Manual Attaching the patient circuit The patient circuit has a long flexible hose and several other parts shown in the diagram It attaches to the ventilator Inspect it every day to e Make sure there are no cracks in the hose e Be certain all the connections are secure and free of leaks Clean the exhalation manifold according to the manufacturer s instructions Each time the Patient Circuit is reassembled you need to do a user self test to make sure the circuit is functioning properly See User self test on page 4 23 LN F AN SS The following instructions are for a reusable patient circuit as illustrated Disposable patient circuits are also available from Puritan Bennett and include instructions EXHALATION MANIFOLD The exhalation manifold directs the flow of gases to and from the patient The exhalation manifold is also used to control PEEP and regulate pressure during Pressure Control This assembly consists of a manifold body a mushroom valve and a cap Refer to the manufacturer s instructions Before using it with the patient secure all connections and ensure the seating of the mushroom valve November 2003 Achieva Ventilator Clinician s Manual Caution Warning Warning November 2003 Set up During inhalation the mushroom inflates and allows air to enter the lungs During exhalation the mushroom deflates and allows air to be expelled from the lungs Th
115. sents the exclusive obligation of Puritan Bennett and the exclusive remedy of the purchaser regarding defects in the ventilator THIS WARRANTY IS GIVEN IN LIEU OF ANY EXPRESS OR IMPLIED WARRANTIES INCLUDING ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE No person is authorized to modify in any manner Puritan Bennett s obligation as described above F 2 November 2003 Achieva Ventilator Clinician s Manual A AC Power 4 4 Accessories 3 15 Accessory checklist 4 3 Airway pressure B 1 Alarm control light 3 3 Alarm lights 3 2 Alarm Silence Reset switch 3 4 Alarm sounds 6 3 Alarms apnea 6 6 battery charge depleted 6 18 high pressure 6 9 high pressure response to 6 9 invalid I E ratio 6 10 latching and non latching 6 4 latching non latching B 1 leak test failure 6 8 low power 6 16 low pressure 6 6 low pressure response to 6 8 low pressure setting 4 26 oxygen response to 6 15 patient circuit and equipment response to 6 13 power switchover 6 16 power switchover response to 6 16 presilence 6 5 presilencing 6 5 rate error 6 12 resetting 6 5 setting error 6 10 setting error response to 6 12 user self test 6 7 volume error 6 10 Alcohol 8 1 Alerts volume error 6 10 Apnea 5 16 B 1 Apnea alarm 6 6 Apnea alarms 6 7 Arrow keys up and down 3 6 Assist Control B 1 Assist Control mode D 6 D 7 pressure controlled 5 10 volume breaths 5 7 Assist Spontaneous B 1 November 2003 Index Index As
116. sist Spontaneous light 3 3 Attaching the patient circuit 4 12 Audible alarms E 2 B Back and sides of ventilator case 3 10 Back panel label 3 14 Battery external 4 5 internal 4 9 performance 4 7 testing 4 8 Battery charge depleted alarm response to 6 18 Bibliography C 1 Breath rate 3 7 Breaths and ventilation modes D 4 Caregiver 1 Caregiver topics 5 25 Caution explanation of 1 4 Cleaning and sterilization 8 1 Connectors specifications E 5 Continuous Positive Airway Pressure B 2 Contra indications 3 1 Controls 4 21 Controls and display 3 5 Controls specifications E 3 Conventions 1 4 CPAP B 2 D Data transfer remote A 6 Definitions of terms B 1 Description of ventilator 3 1 E Electromatic interference 2 2 Environment specifications E 7 Equipment alarm response to 6 12 Ethylene oxide 8 1 ETO 8 1 Exhale fail alarm 6 6 External battery 4 5 4 6 F Features of ventilators 2 1 Flow 3 7 B 2 Flow trigger 5 4 Front panel 3 2 Fuse changing 8 4 Achieva Ventilator Clinician s Manual November 2003 Achieva Ventilator Clinician s Manual G Glossary B 1 H High pressure 3 8 High pressure alarm response to 6 9 High pressure alarms 6 9 Hours of operation 5 22 I VE ratio 3 8 Indicators specifications E 2 Inlet filter 8 2 Inside door label 3 12 Inspection 4 2 Inspiratory time 3 6 Intended use 3 1 Internal battery 4 9 Introduction to this manual 1 1 Invalid I E ratio alarm 6 10 L Latching alarms 6 4 Leak te
117. st failure alarm 6 8 Lights alarm control 3 3 alarm alert 3 2 Assist Spontaneous 3 3 Local data transfer 5 25 A 3 Low battery power alarms response to 6 17 Low power alarms 6 16 Low pressure 3 8 Low pressure alarm 4 26 6 6 Low pressure alarms response to 6 8 M Maintenance 8 1 Maintenance periodic 8 6 MEK 8 1 Menu selections 5 22 Menu Esc switch 3 6 Meter patient pressure 3 4 Miscellaneous specifications E 8 Mode 3 6 Modem B 2 Monthly safety check 5 17 N Non latching alarms 6 4 Normal events specifications E 2 Note explanation of 1 4 November 2003 Index Index Symbols Nurse call 4 19 Nurse call output B 2 O Operation 5 1 Organizations C 1 Overview of ventilators 2 1 Oxygen 4 15 Oxygen alarm response to 6 15 Oxygen display 3 9 Oxygen fail alarm B 2 P Panel front 3 2 Patient circuit alarm response to 6 12 Patient circuit making attachments 4 12 PEEP 3 7 B 2 Periodic maintenance 8 6 Pneumatic diagram D 1 Positive End Expiratory Pressure 3 7 B 2 Power lights 3 3 Power specification E 1 Power switchover alarm 6 16 Power usage specification E 1 Power AC 4 4 Presilence B 2 Presilencing alarms 6 5 Pressure 3 7 Pressure control B 2 Pressure control in Assist Control mode D 7 Pressure support B 3 Pressure trigger 5 5 5 6 5 23 Print reports A 1 Printing reports directly from the ventilator A 1 Printout sample A 1 R Rate error alarm 6 12 Relief valve test failure 6 9 Remote data transfer A 6 Resettin
118. ted before the data transfer External modem Connect one end of the communication cable to your ventilator s communications port and the other end to your modem Connect the modem to the telephone line per the manu facturer s instructions 2 Make sure the Achieva Report Generator computer is connected to a modem and set to either Remote Attended or Remote Unat tended to wait for a call On the Report Generator application screen select Connection and Remote Attended or Remote Unattended Follow the Download procedure on page A 4 A 6 November 2003 Achieva Ventilator Clinician s Manual November 2003 Appendix B Appendix B Glossary This appendix contains the definitions of terms used in this manual Airway pressure P Measured by the ventilator at the point where the proximal pressure line connects to the patient circuit Alarm latching non latching Latching alarms continue to sound until the Alarm Silence Reset mf sos switch is pressed regardless of whether the alarm condition has been corrected Non latching alarms will stop sounding as soon as the condition is corrected although the alarm LED will stay on until the Alarm Silence Reset 67 sos switch is pressed The user has a menu option to set some alarms those that cause the Low Pressure LED to flash to either latching or non latching operation Alert Alerts signify a condition that occurs between the patient and the ventilator w
119. ter that you wish to change The Use the up and down arrow keys to adjust the parameter s value When the prescribed value is displayed press the Start Enter switch to accept the setting make it unnecessary to select certain other parameters for example spontaneous mode makes it unnecessary to select a breath rate If a parameter is not November 2003 Set up 4 22 Achieva Ventilator Clinician s Manual displayed one of your other selections has made that parameter unnecessary If a setting is flashing Ifa parameter is flashing the ventilator is waiting for you to enter a value for that parameter Use the up and down arrows to select the appropriate value then press Start Enter November 2003 Achieva Ventilator Clinician s Manual Set up While in the Standby mode you can perform tests that assess whether or not the ventilator s pneumatic system is working properly This test requires your assistance The user self test is accessible only when in Standby l While in Standby press the Menu Esc key 2 The user self test is the first item in the menu Press ENTER to begin User Self Test Press the Start Enter 4 1 key The following message will display Occlude patient s end of breathing circuit 4 Block the part of the exhalation manifold that connects to the patient It is important that you make a tight seal and do not let any air escape Warning A ventilator patie
120. the screen press Start Enter to accept the setting and move to the next date or time variable When all six variables have been accepted press Start Enter e then press Menu Esc November 2003 Achieva Ventilator Clinician s Manual Operation What the patient and caregiver must know The following checklist presents a summary of the topics that patients and caregivers must understand in order to use ventilators successfully Some topics do not apply to some patients some patients may require additional information It is the responsibility of the clinician or clinical educator to ensure that the patient and caregiver understand the appropriate topics fully For a detailed list of learning objectives for patients and caregivers see Learning Objectives for Positive Pressure Ventilation in the Home National Center for Home Mechanical Ventilation Denver CO July 1993 This publication is available from Puritan Bennett The patient and caregiver must understand fe need To ventilation The schedule for ventilation The supplies required for ventilation and the sources of each Whom to contact for medical emergencies equipment emergencies or power emergencies How to contact other resources for assistance health aides attendants therapists etc The principles of operation for the ventilator ower sources for the ventilator and how to connect each The settings for the
121. tilator is no longer able to deliver gases at the selected parameters Test the charge level of the internal battery by pushing the Test Battery IT EST switch Read the charge level on the Battery Condition scale of the patient pressure meter A fully charged battery in good condition will register approximately 100 on the scale The ventilator must be operating on internal battery power to obtain a reading of the internal battery s charge level To retain the electrical charge of the internal battery recharge it by plugging the unit into an AC power outlet after each use A fully depleted internal battery will be fully charged in twelve hours Always charge the internal battery before disconnecting AC power from the ventilator November 2003 Achieva Ventilator Clinician s Manual Warning November 2003 Set up Keep the internal battery fully charged at all times The ventilator charges the internal battery when it is connected to an AC power source and is in any operating mode including Standby Every four to six weeks run the ventilator on its internal battery until the low power alarm sounds Immediately switch to AC power and recharge the internal battery for at least twelve hours Batteries contain toxic chemicals and no attempt to remove or replace the internal battery should be made by anyone other than the equipment supplier or a trained service center 4 11 Set up Achieva Ventilator Clinician
122. tor 2 Load the printer with paper and ink as required 3 Connect the printer to power Turn it on and ensure that the printer is Selected or On Line See the printer manufacturer s instructions for details 4 On the ventilator briefly press the Test Battery ET EST switch The printout will contain the ventilator s settings and measured or calculated parameters as of the last breath inspiration and expiration completed before the printout was created Reports are printed automatically e after any alarm e after any parameter change e every four hours November 2003 A 1 Appendix A Achieva Ventilator Clinician s Manual The header of the printout displays model and serial number for the ventilator e blanks for writing in the patient s name and room e date and time of the printout with machine operating hours since the last maintenance e mode and power source at the time of the printout e any alarm condition e latched or non latched Low Pressure alarms See Latching and non latching on page 6 4 The remainder of the printout displays the set and or actual values for e tidal volume and breath rate e inspiratory time and inspiratory to expiratory ratio set and actual for each average and maximum inspiratory flow set and actual for each e sensitivity pressure limit and PEEP settings actual only e selected oxygen concentration set and estimated oxygen concentration e low pressure setting s
123. tor failure 2 4 Ventilator Users Network C 1 Volume 3 6 Volume breath B 4 Volume breaths D 4 Volume error alarm 6 10 Volume error alert 6 10 W Warning explanation of 1 4 Warranty F 2 Waveform D 4 D 6 D 8 Achieva Ventilator Clinician s Manual November 2003 Reorder model number Y 102672 UK rev C 0123 This device complies with the requirements of Medical Device Directive 93 42 EEC P U R T A N Tyco Healthcare Group LP Authorized Representative Nellcor Puritan Bennett Division Tyco Healthcare UK LTD B E N N E T T 4280 Hacienda Drive 154 Fareham Road Pleasanton CA 94588 USA Gosport PO13 OAS U K Toll Free 1 800 635 5267
124. tory time which in combination influence peak flow As peak flows increase i e large tidal volumes combined with short inspiratory times the limit of the oxygen flow capacity is approached The set oxygen concentration cannot be delivered if the flow capacity of the oxygen blender has been exceeded This device does not include an oxygen analyzer Always measure the delivered gases with a calibrated analyzer having high and low concentration alarms in order to ensure that the prescribed oxygen concentrations are delivered to the patient Set up Caution Note Achieva Ventilator Clinician s Manual Altitude changes and oxygen source pressure can affect the ventilator s oxygen blender To ensure correct oxygen blending verify that the correct altitude has been entered into the ventilator s parameters see The Altitude Testing section in this manual Two other methods of supplemental oxygen delivery are available ethe 90 elbow with oxygen fitting ethe oxygen enrichment kit 90 Elbow with oxygen fitting Use the elbow to bleed oxygen directly into the patient circuit This method can achieve concentrations up to 40 Connect the elbow between the bacteria filter and the patient circuit Connect a low pressure oxygen line to the fitting on the elbow Use the formula below to calculate the volume of pure oxygen to be bled into the patient circuit to achieve the desired oxygen concentration BPM x V x 0 21 0 79 LP
125. tude setting Changes in barometric pressure can affect the operation of the Achieva PSO ventilator s oxygen blender Each ventilator must be set for the altitude of the location where it will be used The altitude can be set from O meters 0 feet to 4500 meters 14 760 feet in increments of 100 meters 328 feet To set or change the altitude setting 1 Press the MENU ESC switch The display shows the first menu item 2 Use the up and down arrows to scroll to the message Press ENTER to change operating altitude Press che START ENTER switch The display shows the message Altitude XXXX m XXXXX ft UP DN change ENTER keep 4 Use the up and down arrow keys to select the prescribed altitude setting B Press START ENTER to accept the setting 5 6 November 2003 Achieva Ventilator Clinician s Manual Operation Assist Control mode volume breaths To operate the ventilator in Assist Control mode delivering breaths of a selected volume 2 3 5 6 7 8 9 10 11 12 13 November 2003 Press MENU ESC to enter the ventilator s menu system Set alarm latching see Latching and non latching on page 6 4 or pressure trigger level see Pressure trigger on page 5 5 and or operating altitude see Altitude setting on page 5 6 from the menu as needed From standby press Start Enter 1 to display the parame ters Set MODE to A C Set the prescribed volume Set the prescribed inspi
126. ure trigger on page 5 5 and or operating altitude see Altitude setting on page 5 6 from the menu as needed Select whether or not back up breaths should be delivered For more details see page 5 16 From standby press Start Enter 4 to display the parame ters Set MODE to SPON Set the inspiratory sensitivity to an appropriate level Set pressure support to the prescribed level greater than 0 5 13 Operation 5 14 12 13 14 Achieva Ventilator Clinician s Manual Set PEEP as required Set the low pressure and high pressure alarm levels See Setting the low pressure alarm on page 4 27 If required set F O available only on Achieva PSO3 Set the Expiratory Sensitivity Press Ventilate am to begin breath delivery November 2003 Achieva Ventilator Clinician s Manual Operation Spontaneous mode with CPAP Achieva PS and Achieva PSO To operate the ventilator in Spontaneous mode with CPAP Achieva PS and Achieva PSO 1 Press MENU ESC to enter the ventilator s menu system Set alarm latching see Latching and non latching on page 6 5 or pressure trigger level see Pressure trigger on page 5 5 and or operating altitude see Altitude setting on page 5 6 from the menu as needed Select whether or not back up breaths should be delivered For more details see page 5 16 3 From standby press Start Enter 4 1 to display the parame ters 4 Set MODE to SPON B
127. urs first To display the ventilator operating hours 1 Press the Menu Esc key 2 Press the up or down arrow key until the display screen says Ventilating hours since last maintenance XXX XX The pressure trigger menu selection allows the clinician to enable or disable pressure triggering of breath delivery in addition to flow triggering When using PEEP consider using Pressure Trigger along with the sensitivity setting Flow Trigger See Pressure trigger on page 5 5 November 2003 The date and time menu selection allows you to set the date and time in the ventilator s internal memory This information will appear in the printed reports and the data transferred to the Report Generator software For information on the printed reports see Printing reports from the ventilator on page 1 For information on the Report Generator software see the Achieva Report Generator User s Guide To set the date and time 1 Press the Menu Esc key 2 Press the up or down arrow key until the display screen says Press ENTER to modify Date and Time Press Start Enter 4 The display screen will show the date and time 5 23 Operation 5 24 Achieva Ventilator Clinician s Manual 05 18 96 01 23 30 UP DN change ENTER keep The first variable in the date and time will flash This indicates that this value can be changed Press the up or down arrow key to change the value When the correct setting is displayed on
128. ventilator parameters and the importance of each How to perform a user self test of the ventilator and how to respond if the self test fails The preventive maintenance schedule for the ventilator The ventilator alarm settings with the purpose and function of each How to respond to ventilator alarms What to do if the ventilator alarms inappropriately The parts and purpose ol The patient circuit How and how often to dean and replace the patient circuit DL DJ OO C C C O D C C C D CJ O C How to recognize and respond to problems with the patient circuit The parts and purpose of the tracheostomy and the tracheostomy tube Care of the tracheostomy and tracheostomy tube L C C How to recognize and respond to problems with the tracheostomy and tracheostomy tube The parts and purpose of the nasal mask Care of the nasal mask How to recognize and respond to problems with the nasal mask L CJ C The parts and purpose of the mouth piece DO LJ Care of the mouth piece November 2003 5 25 Operation Achieva Ventilator Clinician s Manual The patient and caregiver must understand fow 0 recognize and respond to Drob ems with the mouth piece A Tnm Dn The purpose of the humidifier or HME How to connect the humidifier or HME to the ventilator and the patient circuit How to clean and ch
129. ventilator s parameters are set as prescribed by the doctor Change them if necessary Press Ventilate an to begin breath delivery 4 Adjust the Low Pressure setting until a low pressure alarm occurs Note that it takes two breath cycles for the alarm to sound Warning Repeat this procedure whenever you change replace remove or reconnect components of the patient circuit or alter the ventilator s parameters Warning It is possible that with the low pressure alarm set as described above the patient s breathing effort will cause continuous low pressure alarms In this case you may lower the low pressure setting until alarms no longer occur during normal operation but an independent method of measuring ventilation will be mandatory November 2003 4 27 Set up Achieva Ventilator Clinician s Manual 4 28 November 2003 Achieva Ventilator Clinician s Manual Operation Chapter 5 Operation This chapter provides information on starting and stopping the ventilator and setting the various modes and menu selections It includes a monthly safety check and a list of the information the patient and caregiver must know to use the ventilator safely and effectively Starting the ventilator Ventilator Menu Esc controls CC JILL J ILL_J Mobe Vi T Sens O
130. ventilators Refer all servicing to qualified personnel To avoid a fire hazard always use the same type and rating of fuses as were originally supplied If the ventilator fails 2 4 The caregiver and where appropriate the patient must be trained to respond to ventilator failure Refer to the Alarms and Troubleshooting chapters in this manual for detailed information November 2003 Achieva Ventilator Clinician s Manual Warning November 2003 Overview Any device is subject to unpredictable failures To ensure patient safety an appropriately trained caregiver must monitor ventilation If the patient s condition warrants the use of an independent secondary alarm or another external monitoring device the physician must prescribe it The physician must also determine to what level the patient may require an alternate means of ventilation in the event of ventilator failure 2 5 Overview Achieva Ventilator Clinician s Manual 2 6 November 2003 Achieva Ventilator Clinician s Manual Description Chapter 3 Description This chapter gives the intended uses and contra indications for Achieva ventilators It describes the features controls and labels on the ventilator Some of the accessories used with Achieva ventilators are also described This device is intended to provide ventilatory support for pediatric and adult patients who require positive pressure mechanical ventilation pediatric patients should weigh no
131. volume breaths in SIMV mode on page D 10 Available on Achieva PS and Achieva PSO only See the waveforms on the following page D 13 Appendix D Achieva Ventilator Clinician s Manual Start E inspiration 15 Eng of ingpieatiny l m mm m mm P 55 l l l l l l l l l l l l l l l l l M E l Variable l S l l l l l l Time l D 14 November 2003 Achieva Ventilator Clinician s Manual CPAP November 2003 Appendix D Continuous Positive Airway Pressure CPAP is available in SIMV all models or Spontaneous modes Achieva PS only Pressure must be set to 0 The ventilator maintains pressure at the selected PEEP over the entire breath cycle Inspiration is triggered by patient generated flow or pressure drop Inspiration is limited by the pressure and is cycled by the patient when flow drops to the Expiratory Sensitivity setting between 15 and 55 of peak flow In SIMV additional mandatory volume breaths will be delivered dependent on the selected Breath Rate See Mandatory volume breaths in SIMV mode on page D 10 See the waveforms on the following page D 15 Appendix D D 16 Start of inspiration Variable i Time Achieva Ventilator Clinician s Manual End of inspiration e sl November 2003 Achieva Ventilator Clinician s Manual Appendix E Appendix E Specifications This appendix provides complete specifications for Achieva ventilators a
132. volumes greater than or equal to 100 ml 21 to 70 for tidal volumes less than 100 ml in 1 increments Accuracy 50 to 90 ml O settings lt 70 10 0 100 to 2200 ml 0 settings lt 50 5 0 all other 0 settings 10 of settings Supply pressures of less than 355 kPa 45 PSIG may result in reduced 0 performance at some settings Optimum performance is achieved at 443 kPa 65 PSIG 0 supply pressure It may take several minutes for the oxygen concentration to stabilize The capacity of the 0 blender is a function of tidal volume and inspiratory time which in combination influence peak flow As peak flows increase i e large tidal volumes combined with short inspiratory times the limit of the 0 flow capacity is approached The set 0 concentration cannot be delivered if the flow capacity of the 0 blender has been exceeded To ensure the prescribed oxygen concentration is delivered to the patient measure the delivered gases with a calibrated oxygen analyzer at all times Altitude 0 to 4500 meters in increments of 100 meters or 0 to 14 760 feet in increments of 328 feet November 2003 Achieva Ventilator Clinician s Manual Appendix E Connectors Communications Port RS 232 connector for Report generator computer printer or external modem 02 Inlet Achieva PSO 9 16 18 DISS 1240 THD External Battery Connector 3 pin male receptacle for 24 Volt DC input

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