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Note - Frank`s Hospital Workshop

1. Cardinal Health Part Number Description 10635 Tracheal catheter 5 FR Disposable 50000 09910 Tracheal catheter extension tube 50000 40034 Tracheal catheter adapter 7003100 Adult esophageal catheter 8 FR 7003401 Pediatric esophageal catheter 6 FR 50000 09920 Esophageal catheter extension tube 16401 Bicore Accessory Kit 7003300 Nasogastric Pressure Monitoring Tube Set 16FR Adult 7003402 Nasogastric Pressure Monitoring Tube Set 7FR Ped 7003503 Esophageal Pressure Monitoring Tube Set 5FR Ped Neo Capnography Parts and Accessories Cardinal Health Part Description Number 16578 Reusable CO2 Sensor box of 1 16605 Single Patient Use Adult Airway Adapters box of 10 16606 Single Patient Use Neonatal Airway Adapters box of 10 16607 Reusable Adult Airway Adpater box of 1 16608 Reusable Neonatal Airway Adapter box of 1 79044 5 CO2 Calibration Check Gas box of 4 L2786 A 4 Appendix A Contact amp Ordering Information Operator s manual This page intentionally left blank L2786 AVEA ventilator systems B 1 Appendix B Specifications Pneumatic Supply Air or Heliox Supply Pressure Range Temperature Humidity Minimum Flow Air Inlet Fitting 20 to 80 psig 1 4 to 5 5 bar Supply Air 20 to 80 psig 1 4 to 5 5 bar Supply Heliox 80 20 Heliox only 3 to 10 psig 0 2 to 0 7 bar Compressor Air 5 to 40 C 41 to
2. Figure 2 31 Attaching the Air Hose to the water trap filter Note The fitting for Air will not accept a Heliox connection and vice versa L2786 2 22 Chapter 2 Unpacking amp Setup Operator s manual Utilities Screens Configuration Tab VOLUME A C paket Input Output Date Time Monitoring English Off 3 20 or bpm mL Limin amp sec Rate Volume Peak Flow Insp Pause Calc Ve L 0 703 1 40 Figure 2 32 Utilities Screen Alarm Loudness 1 0 Vf 21 od cmH20 Eatin Bey oe PEEP Flow Trig Fi02 To change alarm sound levels depress and hold the increase or decrease soft keys until the desired level is reached The Alarm Test banner will appear during the adjustment Enable Disable 02 Alarm The High and Low oxygen alarms can be disabled in the event of a failure of the oxygen sensor while the ventilator is in use To disable the alarm depress the Enable Disable O2 soft key to re enable depress the soft key again Note The oxygen alarms cannot be disabled while heliox is in use Powering the ventilator off and back on again will automatically re enable the oxygen alarms WARNING Although disabling the oxygen alarms will not effect oxygen titration an external analyzer should be placed in line in the breathing circuit until the oxygen sensor has been replaced L2786 AVEA ventilator systems Chapter 2 Unpacking am
3. Adult Setting Pediatric Setting Neonate Setting ET tube Diameter 7 5mm 5 5mm 3 0 mm ET Tube Length 30 cm 26 cm 15 cm Artificial Airway Off Off Off Compensation Leak Off Off Off Compensation Circuit 0 0 ml cmH20 0 0 ml cmH20 0 0 ml cmH20 Compliance NOT active in Compensation Neonates Circ Comp Humidification Active On Active On Active On Patient Weight 1 kg 1 kg 1 kg Primary Controls Adult Setting Pediatric Setting Neonate Setting Breath Type Mode Volume A C Volume A C TCPL A C Breath Rate Rate 12 bpm 12 bpm 20 bpm Tidal Volume 500 ml 100 ml 2 0 ml Volume Peak Flow 60 L min 20 L min 8 L min Inspiratory 15 cmH20 15 cmH20 15 cmH20 Pressure Insp Pres Inspiratory Pause 0 0 sec 0 0 sec 0 0 sec Insp Pause Inspiratory Time 1 0 sec 0 75 sec 0 35 sec Insp Time PSV 0 cmH20 0 cmH20 0 cmH20 PEEP 6 cmH20 6 cmH20 3 cmH20 Inspiratory Flow 1 0 L min 1 0 L min 0 5 L min Trigger Flow Trig 02 40 40 40 Advanced Settings Adult Setting Pediatric Setting Neonate Setting Vsync 0 off 0 off N A Vsync Rise 5 5 N A Sigh 0 off 0 off N A Waveform 1 Dec 1 Dec 1 Dec Bias Flow 2 0 L min 2 0 L min 2 0 L min Inspiratory 3 0 cmH20 3 0 cmH20 3 0 cmH20 Pressure Trigger Pres Trig PSV Rise 5 5 5 PSV Cycle 25 25 10 2 38 Chapter 2 Unpacking amp Setup Operator s manual Adult Setting Pediatric Setting Neonate Setting
4. L2786 6 8 Chapter 6 Infant NCPAP Operator s manual This page intentionally left blank L2786 AVEA ventilator systems 7 1 Chapter 7 Alarms and Indicators Status Indicators The ventilator displays the following status indicators Compressor Active If the internal compressor is active the Compressor Active icon shown here will display at the bottom of the touch screen with no accompanying tone Heliox Source Connected If Heliox gas is connected this green icon displays in bottom right of the touch screen Mains Battery Indicators There are visual status indicators on the ventilator front panel for the mains power and the internal and external batteries Figure 7 1 The sequence in which the power sources are used by the ventilator is e Mains AC Power e External Battery if installed e Internal Battery Power On Indicator The green Power On indicator lights up whenever the power switch is on and power is being supplied from any of the available power sources AC external battery or internal battery On battery indicator while operating on internal or external battery a battery icon will blink in the lower right hand corner of the display AC Power Indicator The green AC indicator is on whenever the ventilator is connected to AC power It displays whether the power switch is on 1 or off O Operating On Battery Indicator ae When operating on battery power Internal o
5. Cardinal Health symbol HOT WIRE FLOW SENSOR connection Cardinal Health symbol ANALOG IN OUT connection Cardinal Health symbol Display the MAIN SCREEN Cardinal Health symbol DO NOT BLOCK PORT Cardinal Health symbol EXTERNAL BATTERY connection Cardinal Health symbol Indicates GAS ID port Cardinal Health symbol OXYGEN SENSOR connection L2786 AVEA ventilator systems XV L2786 Cardinal Health symbol OVERPRESSURE relief Cardinal Health symbol REMOTE NURSE CALL connection Cardinal Health symbol USER INTERFACE MONITOR connection Cardinal Health symbol This symbol indicates an INTERNAL BATTERY FUSE Cardinal Health symbol This symbol indicates ALARM LOUDNESS Cardinal Health symbol This symbol indicates that the AVEA is being powered by the INTERNAL BATTERY only e Di COPA Cardinal Health symbol This symbol indicates that the HELIOX configuration is in use xvi Operator s manual This page intentionally left blank L2786 AVEA ventilator systems 1 1 Chapter 1 Introduction The AVEA is a fourth generation servo controlled software driven ventilator It has a dynamic range of breathing gas delivery that provides for neonatal through adult patients Its revolutionary user interface module UIM provides maximum flexibility with simple operator interaction It has a flat panel color LC
6. L2786 J 2 Appendix J Electromagnetic Declarations Operator s manual 60601 1 2 IEC 2001 E Table 202 Guidance and manufacturer s declaration electromagnetic immunity The AVEA Ventilator is intended for use in the electromagnetic environment specified below The customer or the user of the AVEA Ventilator should assure that it is used in such an environment Immunity Test IEC 60601 Test level Compliance level Electromagnetic environment guidance IEC 61000 4 8 Electrostatic discharge ESD 6 kV contact 6 kV contact Floors should be wood concrete or ceramic tile If floors are covered with synthetic material IEC 61000 4 2 8kV air 8 kV air the relative humidity should be at least 30 Electrical fast 6 kV for power supply 6 kV for power supply transient burst lines lines Mains power quality should be that of a typical commercial or hospital environment IEC 61000 4 4 1 kV for input output lines 1 kV for input output lines Surge 1 kV differential mode 1 kV differential mode Mains power quality should be that of a typical commercial or hospital environment IEC 61000 4 5 2 kV common mode 2 kV common mode Voltage dips short lt 5 Ur lt 5 UT interruptions and voltage gt 95 dip in Ur gt 95 dip in U7 Mains power quality should be that of a typical variations on power for 0 5 cycle for 0 5 cycle commercial or hospital environment supply input li
7. Manual Alarms Checks High Rate Alarm Low Vte Alarm High Vte Alarm Low Ve Alarm High Ve Alarm Low Ppeak Alarm High Ppeak Alarm Low PEEP Alarm Apnea Interval Alarm Extended High Ppeak Alarm Circuit Disconnect Alarm Circuit Occlusion Alarm Loss of AC Alarm High O Alarm Low O Alarm Hogg pguo uouu oguga gada0a OOo Hogg oguouduouuogugaaada0a OOo Signature of tester 2 40 Chapter 2 Unpacking amp Setup Operator s manual AVEA Troubleshooting Remove ventilator from patient with any potential problem Symptom Problem Solution s Will not pass EST Fails Leak Circuit wye not fully occluded Ensure circuit wye is fully occluded Leak in patient circuit Check for leaks in circuit and reseat circuit connections to ventilator Replace circuit if necessary Filter cartridge not properly seated Remove exhalation cartridge and check condition of connections Reinstall and recheck Replace if necessary Leak in exhalation corner Replace exhalation diaphragm Will not pass EST Fails O2 Connector on O sensor not Check sensor connection calibration connected properly Inlet gas pressure too low Verify inlet air and oxygen pressure above 20psig Defective O sensor Replace O2 Sensor No reading from proximal flow sensor Sensor Patient size incompatible See the operators manual for correct sensor mode configurations S
8. OBO OODONADBH AS S 00000000000 Figure 2 38 Analog Ground Pins Note At least one analog ground is required for safe and accurate signal output and input One analog ground is sufficient for any and all of the other signals L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 29 Table 2 1 ILV and Analog I O pin configuration PIN FUNCTION 1 Analog Input Channel 0 14 Analog Input Channel 1 18 ILV In 6 ILV Out 20 Factory Use Only DO NOT CONNECT 22 Analog Output PRESSURE 23 Analog Output FLOW 24 Analog Output VOLUME 25 Analog Output BREATH PHASE 5 9 10 11 12 13 Ground Analog Note At least one analog ground is required for safe and accurate signal output and input One analog ground is sufficient for any and all of the other signals RS 232 Output Sets the RS 232 output format for digital communications via the port labeled MIB The RS 232 output configuration provides the following setting choices Generic Select 8 N 1 and Baud Rates of 9600 2400 4800 9600 19200 38400 57600 or 115200 or Select CR LF or CR Only VOLUME A C 0 19 Vte Analog Input Scale 24 bpm Rate 1 2 0 EE 69 cmH20 Ppeak 6 24 0 20 bpm Rate Calc Ve 4 80 Configuration UTILITY Input Output Date Time Analog Ou RS 232 Output Monitoring tput Type Wye Flow oneri A oe 0 00
9. Acceptance of any combination of settings that will produce an I E Ratio of 4 1 or greater Maximum 3 sec Inspiratory Time Acceptance of any combination of settings when size is NEO that will produce an l Time of greater than 3 seconds Maximum 5 sec Inspiratory Time Acceptance of any combination of settings when size is PED or ADULT that will produce an l Time of greater than 5 seconds Invalid Calibration Service State Only Validation failure while calibration dialog box is active for selected device Error saving Serial Model Number Service State Only On accept of Serial Number or Model Number Change Clear Messages Service State Only Validation success while calibration dialog box is active for selected device FCV Characterization in progress Service State Only On start of Flow Control Valve characterization procedure FCV Characterization complete Service State Only On successful completion of Flow Control Valve characterization procedure FCV Characterization failed Service State Only Unsuccessful completion of Flow Control Valve characterization procedure Validation failure characterization and tuning data Installed Software Version Power Up Current Time Date and Runtime Hours Main key pressed DPRAM Comm Error Ctrl Loss of Communication with Control microprocessor Printing Print Screen button was pressed commen
10. Characterizing Proximal Pressure 9 sec Cancel Figure 6 4 Calibration Progress Message If calibration is successful the following message appears CALIBRATION SUCCESSFULLY COMPLETED RECONNECT Expiratory Limb of Circuit at Wye Connect NCPAP Device to Patient Press Continue Continue Figure 6 5 Calibration Successfully Completed Screen Note If the calibration test fails check the following Ensure the patient was disconnected during the calibration Ensure the circuit connections are secure Ensure there was no movement of the circuit during the calibration Ensure the prongs are open during the test Ensure the expiratory limb of the circuit was disconnected before starting the calibration If failure of the calibration persists after checking all of the above remove the ventilator from service and have it checked by a qualified technician 5 Reconnect the expiratory limb of the circuit at the patient wye 6 Connect the Nasal CPAP device to the patient and touch Continue The patient will be supported initially by the default value of 2 cmH 0 of continuous positive airway pressure 7 Set the prescribed level for nCPAP Pressure and or F102 by touching the primary control turning the Data Dial until the desired value is displayed and by either touching the primary control again or by touching the ACCEPT membrane key adjacent to the Data Dial to activate the new setting L2786
11. Select MONITOR from the selection box that appears Figure 4 16 Screen Selection The monitor screen can display a total of 15 different monitored values simultaneously Monitor Displays are updated at the start of the next inspiration or every 10 seconds whichever occurs first Each value can be independently selected from the available choices see Table 4 2 Use the touch screen to select and highlight the monitor you wish to set Turn the data dial beneath the touch screen to scroll through the menu choices To accept your selection either touch the highlighted display or press the accept button adjacent to the data dial Figure 4 17 18 5 0 0 26 7 0 0 Vie j VieiKa j thi yuk 010 0 0 muk l mi a Spon ViKg Mand Vt Mand Wkg ON ooa AONE Spon Velko H y L j VeilKg lt SponVe Figure 4 17 The Monitor Screen L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 21 Table 4 2 Monitored Values Menu Choices For a full description of the specifications and calculation of monitored displays see Appendix D Monitor Ranges and Accuracies Note Depending on the model and options not all of the following displays may be available Display Value ml Expired tidal volume Vte ml kg Expired tidal volume adjusted for patient weight Vtelkg ml Inspired tidal volume Vti ml Inspired tidal volum
12. EtCO2 Avg VCO2 Avg Figure 5 3 Monitoring Tab Utility Screen Note Capnography requires either a proximal flow sensor or circuit compliance compensation to be active If CO2 monitoring is enabled but a proximal flow sensor or circuit compliance compensation is not active an alert dialog box appears Volumetric Capnometry requires wye flow sensor or compliance compensation to be active Continue Figure 5 4 Vco2 Alert Dialog If volumetric capnography is required add a proximal flow sensor or enable circuit compliance compensation or do both and then re enable CO2 monitoring as described above otherwise only the PCO2 waveform and End tidal CO2 monitor are available Remove the appropriate airway adapter from its packaging and make sure it is undamaged and ready to use 5 4 Chapter 5 Volumetric Capnography Operator s manual Insert the airway adapter into the CO sensor The adapter clicks into place when properly inserted Figure 5 5b Pediatric Neonatal Adapter Figure 5 5 Aiarway adaptors Perform the sensor zero procedure by following the instructions in the section Zeroing the CAPNOSTAT 5 on page 5 12 The zeroing procedure must also be performed when switching between disposable and reusable airway adapters After the sensor is successfully zeroed place the airway adapter and sensor into the ventilator circuit between the wye and endotracheal tube and any adapters as shown i
13. Figure 3 13 PSV Waveform In Figure 3 13 breath number 1 represents the flow tracing which occurs when the PSV level is insufficient to meet the patient demand Breath two shows resolution after increasing the PSV level slightly Pressure tracing will show a similar appearance L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 21 Ventilation Modes PRESSURE L2786 Leak Compensation The ventilator incorporates a leak compensation system This system compensates for baseline leaks at the patient interface To activate leak compensation use the touch screen control displayed in the Setup screen Assist Control Ventilation A C This is the default mode for all patient types In Assist Control ventilation mode all breaths initiated and delivered are mandatory breaths The initiation of a breath is triggered by one of the following e Patient effort activates the inspiratory trigger mechanism e The breath interval as set by the RATE control times out e The operator presses the MANUAL BREATH key Initiation of a breath by any means resets the breath interval timing mechanism It is possible for the patient to initiate every breath if he she is breathing faster than the preset breath rate If the patient is not actively breathing the ventilator automatically delivers breaths at the preset interval set breath rate TIME Mandatory Breath Breath interval expired Mandatory Breath Patient triggered
14. Figure 3 14 Assist Control Ventilation Waveform 3 22 Chapter 3 Ventilator Operation Operator s manual Pressure Synchronized Intermittent Mandatory Ventilation SIMV In SIMV mode the ventilator can deliver both mandatory and demand breath types Mandatory breaths are delivered when the SIMV time window is open and one of the following occurs A patient effort is detected The breath interval has elapsed with no patient effort detected The MANUAL BREATH key has been pressed Assist Window Open Patient triggered Volume breath 4 Pressure supported breath Figure 3 15 SIMV Waveform The breath interval is established by the preset breath rate It resets as soon as the interval time determined by the set breath rate has elapsed or when the MANUAL BREATH key is pressed L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 23 L2786 Airway Pressure Release Ventilation APRV BIPHASIC APRV BiPhasic is a Time Cycled Pressure mode in which the ventilator cycles between two different baseline pressures based on time which can be synchronized with patient effort Controlled ventilation can be maintained by timed cycling the transitions between baseline pressures Additionally pressure support can be added to improve comfort for the spontaneous breathing patient In this mode the patient is allowed to breathe spontaneously at two preset pressure levels These are set using the Pres Hig
15. Figure 5 15 CO Calibration Message L2786 5 16 Chapter 5 Volumetric Capnography Operator s manual Attach a regulated flowing gas mixture of 5 CO 0 03 balance nitrogen N2 to the airway adapter Set the flow rate of the calibration gas to 2 5 liters per minute Allow 10 seconds for the reading to stabilize The expected reading is 5 0 26 Note While the Calibration Check routine is in process all CO alarms are suspended The alarms resume when the procedure is complete L2786 AVEA ventilator systems 6 1 Chapter 6 Infant NCPAP Overview Infant Nasal CPAP is a spontaneous mode of ventilation In this mode no mechanical positive pressure breaths are delivered and no inspiratory triggers are required A patient spontaneously breathes at an elevated baseline pressure level called the nCPAP level Note Nasal CPAP is an available option in the Infant Mode Select Screen only Circuit Compatibility AVEA nCPAP utilizes standard two limbed neonate patient circuits and nasal prongs for the patient interface The following nasal CPAP prongs have been approved for use HUDSON Infant Nasal CPAP Cannula Sizes 0 through 4 Hudson RCI Research Triangle NC NCA Infant Nasal Cannula Sizes 7 5F 9F 10 5F 12F 15F CooperSurgical Inc Trumbull CONN NEOTECH Binasal Airway Sizes 3 0 mm 3 5 mm 4 0 mm NEOTECH Products Inc Valencia CA ARGYLE Infant Nasal Cannula S
16. The Alarms Test Note To ensure proper calibration of the oxygen sensor you should always perform an EST prior to conducting Manual Alarms Testing WARNING User Verification Testing should always be done off patient CAUTION Following each alarm verification test ensure that the alarm limits are reset to the recommended levels shown in this chapter before proceeding to the next test Test Setup Requirements Adult Setting Pediatric Setting Neonate Setting Air Supply Pressure gt 30 psig 2 1 bar Same Same O2 Supply Pressure gt 30 psig 2 1 bar Same Same AC Line Voltage 115 10 VAC Same Same Patient Circuit 6 2 m Adult 6 2 m Adult Infant Compliance 20 ml cmH20 20 ml cmH20 N A Resistance 5 cmH 0 L sec 5 cmH 20 L sec N A To perform the Alarms Test on the AVEA ventilator using default settings complete the following steps A table describing the default settings for Adult Pediatric and Neonatal patient sizes is included at the end of the Alarms Test section Make the appropriate connections for air and O2 gas supply Connect the power cord to an appropriate AC outlet Attach an appropriate size patient circuit and test lung to the ventilator 2 Power up the ventilator and select NEW PATIENT when the Patient Select Screen appears Accept this selection by pressing PATIENT ACCEPT This will enable default settings for the Manua
17. The CO Zero and calibration check controls are available only when CO is enabled and a sensor has been connected and has completed initialization This initialization may take up to five seconds Calibration Check This control provides access to a calibration check procedure This procedure needs to be done only during the yearly preventative maintenance procedure See the section Checking the Accuracy of the CAPNOSTAT 5 on page 5 14 Monitored Values End Tidal CO EtCO The patient s peak expired CO2 as measured and reported by the CO2 sensor in the airway EtCOz is measured for each breath The display is either a breath by breath measurement or an averaged measurement Range 0 150 mmHg 0 20 0 kPa Resolution 0 1 mmHg 0 01 kPa or three significant digits whichever is greater Accuracy 2 mmHg for 0 40 mmHg 5 of reading for 41 70 mmHg 8 of reading for 71 100 mmHg 10 of reading for 101 150 mmHg Note The minimum differential between inspired and expired CO2 must be 5 mmHg 0 7kPa or greater WARNING Do not use EtCO as basis for changing ventilation parameters without reference to clinical condition and independent monitors such as blood gas CO Elimination Vco The amount of CO eliminated every minute This is calculated over each minute and then averaged over the set VCO2 averaging time Range 0 999 mL min Resolution 0 1 mL or
18. Meaning Symbol 03 02 IEC 60878 Indicates ATTENTION consult ACCOMPANYING DOCUMENTS Symbol 5016 IEC 60417 This symbol indicates a FUSE Symbol 5034 IEC 60417 Symbol 01 36 IEC 60878 This symbol indicates INPUT Symbol 5035 IEC 60417 Symbol 01 37 IEC 60878 This symbol indicates OUTPUT Sirs Symbol 5031 IEC 60417 This symbol indicates DIRECT CURRENT DC Symbol 5019 IEC 60417 Symbol 01 20 IEC 60878 This symbol indicates protective EARTH ground Symbol 5021 IEC 60417 Symbol 01 24 IEC 60878 This symbol indicates the EQUIPOTENTIAL connection used to connect various parts of the equipment or of a system to the same potential not necessarily being the earth ground potential e g for local bonding Symbol 5333 IEC 60417 Symbol 02 03 IEC 60878 This symbol indicates TYPE B equipment which indicates equipment that provides a particular degree of protection against electric shock particularly with regards to allowable leakage current and reliability of the protective earth connection Symbol 5032 IEC 60417 Symbol 01 14 IEC 30878 This symbol is located on the rating plate It indicates the equipment is suitable for alternating current Symbol 5007 IEC 60417 Symbol 01 01 IEC 60878 Indicates ON Power Symbol 5008 IEC 60417 Symbol 01 02 IEC 60878 Indicates OFF Power to gt A ACCEPT Symbol 0651 ISO 7000 Horizontal return
19. PSV Tmax 5 sec 0 75 sec 0 35 sec Machine Volume OL 0 ml 0 ml Mach Vol Volume Limit 2 50 L 500 ml 300 0 ml Vol Limit Inspiratory Rise 5 5 5 Insp Rise Flow Cycle 0 off 0 off 0 off T High PSV Off Off N A T High Sync 0 0 N A T Low Sync 0 0 N A Demand Flow On On On Alarm Settings Adult Setting Pediatric Setting Neonate Setting High Rate 75 bpm 75 bpm 75 bpm High Tidal Volume 3 00 L 1000 ml 300 ml High Vt Low Tidal Volume 0 0L 0 0 ml 0 0 ml Low Vt Low Exhaled 1 0L 0 5L 0 5L Minute Volume Low Ve High Exhaled 30 0 L min 30 0 L min 5 0 L min Minute Volume High Ve Low Inspiratory 8 cmH20 8 cmH20 5 cmH20 Pressure Low Ppeak High Inspiratory 40 cmH20 40 cmH2 0 30 cmH20 Pressure High Ppeak Low PEEP 3 cmH20 3 cmH20 1 cmH20 Apnea Interval 20 sec 20 sec 20 sec Auxiliary Controls Adult Setting Pediatric Setting Neonate Setting Manual Breath Suction 1 02 79 79 20 Nebulizer Inspiratory Hold Insp Hold Expiratory Hold Exp Hold L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 39 AVEA User Verification Test Checklist L2786 Machine Serial Number Test Date TEST PASS FAIL Automated Tests Power on self test Patient circuit leak test OL OL Patient circuit compliance measurement Two point calibration of the oxygen sensor
20. oxygen gas This lower gas density allows the same volumetric tidal volume of gas to be delivered to the patient at a significantly lower airway pressure Additionally the low density properties of the gas allow it to diffuse past airway obstructions or restrictions much easier than nitrogen oxygen gas mixtures Note The Heliox smart connector is designed for use with an 80 20 Heliox tank only Only a mixture of 20 oxygen and 80 Helium can be used as the Heliox gas supply If Heliox gas is connected this green icon displays in bottom right of the touch screen To set the Helium Oxygen mixture during administration simply set the desired F102 the balance of the breathing gas is Helium For example A set Fl02 of 35 will deliver a 65 35 Heliox mixture to the patient L2786 AVEA ventilator systems Chapter 1 Introduction 1 5 L2786 WARNING Connection of a gas supply at the Helium Oxygen mixture inlet that does not contain 20 oxygen can cause hypoxia or death Although an 80 20 mixture of Helium and Oxygen is marketed as medical gas the Helium Oxygen gas mixture is not labeled for any specific medical use Note Hot wire flow sensors will not function with Heliox gas mixtures During Heliox delivery a variable orifice flow sensor should be used for monitoring delivered volumes at the proximal airway Note Heated humidifier performance should be carefully monito
21. 1 4 Chapter 1 Introduction Operator s manual Note Although circuit compliance is displayed on the Setup screen it is not active for neonatal patients High circuit compliance with small tidal volumes may result in extended inspiratory times This is a result of the delivery of the circuit compliance volume at the set flow rate Setting extremely small delivered tidal volumes with Circuit Compliance Compensation not active and using a proximal flow sensor may result in assertion of Patient Circuit Disconnect Alarms Humidification You can select active or passive humidification ON active or OFF passive Active humidification assumes 99 RH passive assumes 60 RH when using an HME This feature adjusts the BTPS correction factor to correct exhaled tidal volumes Range Off On Default Active ON Note Incorrect setting of the Humidification feature will affect monitored exhaled volume accuracy Heliox Delivery Comprehensive only option on Standard Using patented Smart connector technology the Comprehensive model AVEA can deliver Heliox blended gas instead of Medical air By simply changing a connector on the back panel the ventilator identifies the gas input and adjusts to accommodate the change All volumes numeric and graphic are automatically compensated for accurate display The clinical benefits of helium oxygen gas are based on its significantly lower gas density when compared to nitrogen
22. D x 10 5 H or 43 2 cm X 40 6 cm X 26 7 cm UIM 16 25 W x 2 5 D x 13 75 H 41 3 cm X 6 4 cm X 34 9 cm Weight Ventilator w UIM no compressor lt 73 Ibs 33 1 kg Ventilator w UIM and Compressor lt 80 Ibs 36 3 kg Accessories Pall Microbial Filter Resistance The exhalation filter supplied with your AVEA ventilator is manufactured by Pall Medical of Ann Arbor MI USA The published maximum resistance of this filter is 4cmH20 at 100 L min for the 725 filter Compliance The compliance for the filter is lt 0 4 ml cmH20 Materials Materials used in the construction of the filter have passed USP Class VI 121 C Plastic and Cytotoxicity test For further information please contact Pall Medical Water Trap Resistance The resistance of the internal exhalation water trap assembly including the collection bottle is lt 0 5 cmH20 at 50 L min Compliance The compliance of the internal exhalation water trap assembly including the collection bottle is lt 0 2 ml cemH20 L2786 B 10 Appendix B Specifications Operator s manual AVEA Disposable Expiratory Filter Water Trap SPECIFICATIONS Viral amp Bacterial Filtration Efficiency VFE amp BFE Greater than 99 999 Particle Filtration Efficiency PFE 99 97 of 0 3 Tm nominal particle size at 60 L min flow Inlet Connector 22 mm male with a 15 mm female conical connector Outlet Connector 22 mm male with a non stand
23. Pao Fio Ratio P F The Paos Fio ratio is a simple assessment of gas exchange This parameter is calculated from the Fio monitor value and an arterial blood oxygen measurement entered by the clinician PaO FIO OI PIF Note Because PAO may be entered in either mmHg or kPa the normal range for parameters OI and P F differ depending on the setting of the CO units control L2786 AVEA ventilator systems J 1 Appendix J Electromagnetic Declarations 60601 1 2 IEC 2001 E Table 201 Guidance and manufacturer s declaration electromagnetic emissions The AVEA Ventilator is intended for use in the electromagnetic environment specified below The customer or the user of the AVEA Ventilator should assure that it is used in such an environment Emissions test Compliance Electromagnetic environment guidance The AVEA Ventilator uses RF energy only for its internal function Therefore its RF RF emissions Group 1 emissions are very low and are not likely to cause any interference in nearby CISPR 11 electronic equipment RF emissions Class B CISPR 11 The AVEA Ventilator is suitable for use in all establishments including domestic Harmonic emissions Class A establishments and those directly connected to the public low voltage power supply that supplies buildings used for domestic purposes IEC 61000 3 3 Voltage Fluctuation Complies Flicker emissions IEC 61000 3 3
24. patient effort was detected Alarms All currently available alarms shall be active during the AutoPEEP maneuver To Perform an AutoPEEP Maneuver The AutoPEEP maneuver allows the measurement of PEEP generated within the breathing system patient and circuit during an expiratory hold maneuver This maneuver requires a passive patient From the Maneuvers Screen select AutoPEEP The AutoPEEP maneuver screen allows the operator to set Sensitivity This sets the sensitivity threshold that the ventilator uses to detect patient effort during the AutoPEEP Maneuver The default position is three centimeters but can be adjusted by the operator to assure accurate sensitivity in all applications Start Stop Starts and Stops the maneuver To execute an AutoPEEP maneuver the operator sets the Sensitivity appropriate for the patient and presses the Start softkey The ventilator will then close the inspiratory and expiratory valves and allow the pressure to equilibrate between the patient and the breathing circuit At the completion of the maneuver the ventilator will display the AutoPEEP and dAutoPEEP values in their respective windows on the maneuver screen The AutoPEEP and dAutoPEEP will also be available as trended data on the Trends screen The maneuver can be aborted at anytime by pressing the Stop soft key Note The AutoPEEP value will be set at the next mandatory breath interval or 5 seconds whichever is sooner L2786 AV
25. 104 F Dew Point of gas should be 1 7 C 3 F below the ambient temperature minimum 80 L min at 20 psig 1 4 bar CGA DISS type body No 1160 NIST fitting per BS 5682 1984 Air also available Heliox Inlet Fitting CGA DISS type body No 1180 NIST fitting per BS 5682 1984 Heliox also available Oxygen Supply Pressure Range 20 to 80 psig 1 4 to 5 5 bar Supply Oxygen Temperature 5 to 40 C 41 to 104 F Humidity Dew Point of gas should be 1 7 C 3 F below the ambient temperature minimum Minimum Flow 80 L min at 20 psig 1 4 bar Inlet Fitting CGA DISS type body No 1240 NIST fitting per BS 5682 1984 O2 also available Electrical Supply AC Power Supply The ventilator operates within specification when connected to the following AC power supplies Nominal Voltage Range Frequency Range 100 VAC 85 to 110 VAC 47 to 65 Hz 120 VAC 102 to 132 VAC 55 to 65 Hz 230 VAC 196 TO 253 VAC 47 to 65 Hz 240 VAC 204 TO 264 VAC 47 to 65 Hz L2786 B 2 Appendix B Specifications Operator s manual DC Power Supply The ventilator can also operate from a 24 VDC power source internal or external battery Internal Battery The Internal Battery requires a minimum charge time of 4 hours to achieve a full charge Under normal operating conditions the internal battery is capable of powering the ventilator alone for 1 hour and powering the ventilator and compressor for 30 minutes when fully charged The ventilator should b
26. 150 kHz to 80 MHz IEC 61000 4 6 outside ISM bands d m 1 207 10 Vrms 10V 150 kHz to 80 MHz In ISM bands2 _ a 1 24F 80 MHz to 800 MHz Radiated RF 10 Vim 10 Vim 80 MHz to 2 5 GHz 2 Pearman d 2 89 800 MHz to 2 5 GHz Where is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and amp is the recommended separation distance in metres m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range 4 Interference may occur in the vicinity of equipment marked with the following symbol Ko NOTE 1 At 80 MHz and 800 MHz the higher frequency range applies NOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorbtion and reflection from structures objects and people a The ISM industrial scientific and medicinal bands between 150 kHz and 80 MHz are 6 765 MHz to 6 795 MHz 13 553 MHz to 13 567 MHz 26 957 MHz to 27 283 MHz and 40 66 MHz to 40 70 MHz The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2 5 GHz are intended to decrease the likelihood that mobile portable communications equipment could cause interference if it is inadvertently brought into patient areas For this reason an additional factor of 10 3 is used in calculating the recommende
27. 500 ml Pediatric 2 0 to 300 ml Neonate Defaults 0 50 L Adult 100 ml Pediatric 2 0 ml Neonate Sigh 1 5x Volume Adult Pediatric only Note When operated from the internal compressor the maximum Tidal Volume that the ventilator can achieve is 2 0 L The maximum minute volume that the ventilator is capable of delivering using wall gas supply is at least 60L and using internal compressor is 40L Inspiratory Pressure Insp Pres During a mandatory pressure breath the ventilator controls the inspiratory pressure in the circuit For Pressure amp TCPL breaths the pressure achieved is a combination of the preset Insp Pres level plus PEEP Range 0 to90cmH20 Adult Pediatric 0 to 80 cmH20 Neonate Maximum Flow gt 200 L min Adult lt 120 L min Pediatric lt 50 L min Neonate Default 15 cmH20 Note The ventilator will not allow the operator to set a Peak Inspiratory Pressure Insp Pres or PSV PEEP or baseline pressure in APRV BiPhasic greater than 90 cmH20 The ventilator will deliver an on screen Pop Up Message stating that the Ppeak gt 90 cmH20 The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak to less than or equal to 90 cmH20 L2786 3 36 Chapter 3 Ventilator Operation Operator s manual Peak Flow Peak flow is the flow delivered by the ventilator during the inspiratory phase of a mandatory volume or TCPL breath 3 to 150 L min
28. 50000 09920 Esophageal Catheters PN 7003401 and PN 7003100 Nasogastric Pressure Monitoring Tubes PN 7003300 and PN 7003402 Esophageal Pressure Monitoring Tube Set PN 7003503 AVEA Disposable Water Trap PN 11556 AVEA Disposable Expiratory Filter Water Trap assembly PN 11590 Capnography single patient use airway adapters PN 16605 and PN 16606 The instructions provided above have been validated by the manufacturer of the medical device It remains the responsibility of the processor to ensure that the reprocessing as actually performed using equipment materials and personnel in the reprocessing facility achieve the desired result This normally requires validation and routine monitoring of the process 8 4 Chapter 8 Maintenance and Cleaning Operator s manual Recommended Periodic Maintenance Cardinal Health is committed to product support If you have any questions concerning your ventilator s operation or maintenance contact your product support representative as shown in Appendix A Contact Information The batteries should undergo discharge charge cycling quarterly every three months A Preventive Maintenance service should be performed on your AVEA ventilator once per year Call Cardinal Health Customer Care at the number given in Appendix A to arrange for a qualified Service Technician to perform this WARNING Electric shock hazard Do not remove any of the ventilator covers or panels Refer all servicing t
29. 6 In addition at least one of the analog grounds pins 5 9 10 11 12 or 13 must be connected We recommend using a shielded cable For ILV operation Connect an analog ground on Vent 1 to analog ground on vent 2 e Figure 2 34 e Connect Pin 6 on Vent 1 Master to pin 18 on vent 2 Slave e Connect Pin 18 on Vent 1 to pin 6 on vent 2 YOOOVDOVHADBHBH S VOAOMDOQDOOVODO Figure 2 33 ILV Connection Pin Configuration OHOHOODOVADOBY S VOAOOOODHOAVNDOO D Figure 2 34 Analog Ground Pins L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 25 L2786 Note At least one analog ground is required for safe and accurate signal output and input One analog ground is sufficient for any and all of the other signals Selecting Language Touch the language box and use the data dial to select the desired language Use the Accept key to accept the change All text displayed on the LCD screen will automatically be translated to the set language Note For ease of use all languages appear in their native text in the text selection box on the utilities screen Low Vte Alarm Sensitivity Sets the number of consecutive breaths with an exhaled tidal volume below the Low Vte Alarm setting which are required to sound the alarm The default is 3 breaths the range is 1 5 breaths Increase Fi02 Configures the step increase used during the increase oxygen maneuver Sets the amount of oxygen
30. B 2 Atmospheric amp Environmental Specifications ccccccccccscsesesssssscesesrsrsnsecsesesesrsnsasessesssesseneretanaes B 8 PHYSICAL DIMENSIONS is stuns viisusssstvushaptvuasisersvesssuesinissngisnatopesusshubvenaanis iiiaae SEEDIERE ER B 9 PICCOSSOMMGS wists EEES ETEA AE E E E stecutiesesbevesdueies B 9 Appendix C Pneumatic Diagram ssssssssesssrssnssnnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn C 1 Appendix D Monitor Ranges and Accuracies ssssssssssscseesseesisssteeseeesenees D 1 Appendix E Sensor Specifications amp Circuit Resistance scssssssssee E 1 VarFlex Sensor Specifications cscscsccscscscseserssssccesesrsrsncacecssneneeseceeneacacensesssnsneaceceesenseneneneeananes E 1 Hot Wire Flow Sensor Specifications sssssscssccsscssssseresssssccesesrsnencececsenescenenesacscscsesssnsnsasessenessens E 2 Circuit RESISTANCE TOS isiscssaiccsscancsesnsesusasacsesnscsuszevesestess cutee Kiat inii Varaa Kiai Aa ETATE Eni ARa iaie E 3 Volumetric Capnography Specifications s sssssssssrssrnenrnsresrnsnnnnnenunnnnnnnnnnnnnunnnnnnnnnunnnnnnnnnnnnnnnnnnnnnn E 4 L2786 AVEA ventilator systems vii L2786 Appendix F AVEA Message Bar TexXt csscssssssssssssssssssesenessseseanerssensesesees F 1 Appendix G Advanced Pulmonary Mechanics Monitored Parameters G 1 Appendix H Capnometry Troubleshooting scccssssssssssssssseseseessensenseees H 1 Appendix I Volumetric CO2 Cal
31. Corrective Action CO2 Communication Error Medium priority alarm Ensure the sensor is properly plugged in Reinsert the sensor if necessary If the error persists call technical support CO Sensor Faulty Medium priority alarm Ensure the sensor is properly plugged in Reinsert the sensor if necessary If the error persists call technical support CO Sensor Over Temp Medium priority alarm Ensure the sensor is not exposed to extreme temperatures such as temperatures produced by lamps If the error persists call technical support CO Zero Required Medium priority alarm Check airway adapter and clean if needed If the error persists perform an adapter zero procedure CO Out of Range Medium priority alarm when the CO measured by the sensor exceeds 150 mmHg 20 0 kPa If the error persists perform a zero procedure Check CO Airway Adapter Medium priority alarm Check the airway adapter and clean it if needed If the error persists perform an adapter zero procedure Invalid EtCO2 Medium priority alarm No breaths are being detected by the CAPNOSTAT 5 Ensure spontaneous or mechanical breaths are being delivered to the patient Confirm that the airway adapter is placed in the airway between any connector s and the circuit wye and that the sensor is firmly attached to the adapter L2786 H 2 Appendix H Capnometry Troubleshooting Operator s manual This page intentionall
32. Internal Compressor Option Included Pflex Maneuver Option Included Heliox Delivery Option Included nCPAP Option Included Vco2 Option Option Some AVEA Features Artificial Airway Compensation When Artificial Airway Compensation is turned on the ventilator automatically calculates the pressure drop across the endotracheal tube The AVEA then adjusts the airway pressure to deliver the set inspiratory pressure to the distal carina end of the endotracheal tube This calculation takes into account flow gas composition Heliox or Nitrogen Oxygen Fraction of Inspired Oxygen F102 tube diameter length and pharyngeal curvature based on patient size Neonatal Pediatric Adult This compensation only occurs during inspiration Artificial Airway Compensation is active in all Pressure Support and Flow Cycled Pressure Control Breaths WARNING Activating of Artificial Airway Compensation while ventilating a patient will cause a sudden increase in the peak airway pressures and a resultant increase in tidal volume If you choose to activate Artificial Airway Compensation while the patient is attached to the ventilator you will need to exercise caution to minimize the risk of excessive tidal volume delivery Note Monitored airway pressures inspiratory will be higher than set values when Artificial Airway Compensation is active With an inspiratory pressure setting of zero Artificial Airway Compen
33. L min Inspiratory Time 3 0 sec PEEP 0 cmH20 Flow Trigger 20 L min Pressure trigger 20 cmH20 02 21 no Heliox Bias Flow 2 L min Humidifier Dry chamber inline humidifier power off Patient circuit Clean and dry Expiratory Filter Installed clean and dry Test Lung Not used block the wye 2 Select waveforms Pinsp and Paw 3 With the patient wye blocked allow a TCPL breath to occur and then press the FREEZE key and scroll the Cursor Line with the data dial until it is positioned in the middle of the inspiration portion of the breath 4 Read the pressure from the Pinsp and Paw waveforms from the Cursor Line data 5 Subtract Paw from Pinsp Pinsp Paw X cmH20 6 The resulting pressure difference X cmH20 must not exceed 3 1cmH20 at a flow of 15 L min and there must not have been an occlusion alarm active for that breath 7 Reset the Flow Correction setting in the Utility screen to BTPS normal setting for patient use Note We do not recommend using a neonatal circuit in a pediatric patient size application Circuits that do not pass this test may still be used on patients that have ET tubes less than 3 5 or compliances less than 3 If a neonatal circuit is not available that will pass this test and the patient has an ET tube of 3 5 or greater and a compliance of 3 or greater the recommendation is to switch to pediatric patient size in the patient set up screen and use a pediatric patient ci
34. LPM Default 20 to 20 LPM Expiratory Flow Fexp Minimum 2 to 2 LPM Maximum 300 to 300 LPM Airway Pressure CPAP Level Paw Minimum 1 to 2 cmH20 Maximum 60 to 120 cmH20 Default 20 to 40 cmH20 Inspiratory Pressure PINSP Minimum 1 to 2 cmH20 Maximum 60 to 120 cmH20 L2786 AVEA ventilator systems Chapter 6 Infant NCPAP Messages AVEA Message Bar Text Cause Characterization is Required in Nasal CPAP Mode Key pressed when nasal CPAP characterization is in progress No Advanced Settings in Nasal CPAP Advanced Settings Screen Button was pressed No Alarm Limits in Nasal CPAP Alarm Limits Screen Button was pressed No Manual Breath in Nasal CPAP Manual Breath Button was pressed No Proximal Flow Sensing in nCPAP On detection of a Proximal Flow Sensor in Nasal CPAP Mode Troubleshooting Alarm Priority Possible Causes Actions NCPAP Pressure High Occlusion of expiratory limb Check expiratory limb for Limit of patient circuit kinks and or water Occluded expiratory filter Replace expiratory filter Low NCPAP High Circuit disconnect Check circuit Pressure Circuit leak Check patient interface Patient interface leak High NCPAP High Patient circuit occlusion Check patient circuit Pressure Water in circuit Check nasal prongs Patient interaction Circuit Disconnect High Patient circuit disconnect Check patient circuit
35. O 8 6 BS EN 60601 2 12 2006 EN 60601 1 EN 60601 1 2 ISO 13485 UL 60601 1 CAN CSA C22 2 No 601 1 12 94 R99 EU Notified Body BSI Reg No 0086 Trade names AVEA ventilator systems Manufactured by Cardinal Health 1100 Bird Center Drive Palm Springs California 92262 8099 U S A If you have a question regarding the Declaration of Conformity for this product please contact Cardinal Health at one of the numbers given in Appendix A L2786 x Operator s manual Safety Information Please review the following safety information prior to operating the ventilator Attempting to operate the ventilator without fully understanding its features and functions may result in unsafe operating conditions Warnings and Cautions which are general to the use of the ventilator under all circumstances are included in this section Some Warnings and Cautions are also inserted within the manual where they are most meaningful Notes are also located throughout the manual to provide additional information related to specific features If you have a question regarding the installation set up operation or maintenance of the ventilator contact Customer Care as shown in Appendix A Contact amp Ordering Information Terms WARNINGS identify conditions or practices that could result in serious adverse reactions or potential safety hazards CAUTIONS identify conditions or practices that could result in damage to the ventilator or o
36. Range 0 10 to 3 00L Adult 25to1000 ml Pediatric 2 0 to 300 0 ml Neonate Defaults 3 00 L Adult 1000 ml Pediatric 300 0 ml Neonate Rate Time Alarms Apnea Interval This is a high priority audible visual alarm APNEA INTERVAL is displayed and a high priority tone sounds if the ventilator does not detect a breath initiation by any means within the preset period of time Apnea ventilation will begin when this alarm is activated Range 6 to 60 seconds Default 20 seconds High Rate This is a medium priority audible visual alarm HIGH RATE is displayed and a medium priority tone sounds if the monitored total breath rate exceeds the alarm setting Range 1 to 200 bpm Default 75 bpm Maximum Inspiratory Time Limit Max I Time This is a low priority audible visual alarm I TIME LIMIT is displayed and a low priority tone sounds if the inspiratory time for any breath exceeds the maximum set inspiratory time plus pause time Maximum inspiratory time is 5 0 seconds for adult pediatric and 3 0 seconds for neonate The inspiratory phase of the breath is terminated when this alarm activates lE Ratio Limit I E Limit This is a low priority audible visual alarm 1 E LIMIT is displayed and a low priority tone sounds if the E Ratio for a mandatory breath exceeds 4 1 The inspiratory phase of the breath is terminated when this alarm activates This alarm is not active in APRV BIPHASIC mode L2786 Chapter 7 Alarms and In
37. Set Up button a second time before accepting Set Up will close the window and restore the previous settings The Set Up screen uses an on screen accept button To change patient size without selecting new patient requires that patient Set Up be accepted after selecting patient size Advanced Settings LED Opens the Advanced Settings screen for data entry or adjustment Toggles the screen on amp off Note Pressing the Freeze button while the Advanced Setting window is open will automatically close the window and freeze the graphics Mode Opens the Mode Select screen for data entry or adjustment toggles the screen on or off Pressing the Mode indicator at the top of the touch screen will also access the screen Note Pressing the Mode button a second time before accepting the Mode will close the window and restore the previous settings The Mode screen uses an on screen accept button Event Records an event for future reference Some events are recorded automatically others can be logged manually to display in this screen See Chapter 4 Monitors Displays and Maneuvers for a full list of events L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 7 T Freeze L2786 The FREEZE key freezes the current screen and suspends real time update of screen data until pressed again While the screen is frozen a scrollable cursor appears The Data Dial can be used to scroll the cursor through da
38. Volume threshold setting Range 0 to 75L Adult 0 0 to 30 0 L Pediatric 0 00 to 5 00L Neonate Defaults 30 0 L Adult Pediatric 5 00 L Neonate Low Exhaled Tidal Volume Low V A high priority audible visual alarm shall be activated and LOW TIDAL VOLUME shall be indicated whenever the absolute monitored exhaled tidal volume does not exceed the Low Tidal Volume alarm threshold setting for the Low Vte Sensitivity setting Range Off indicated by 0 00 to3 00L Adult Off indicated by 0 to 1000 mL Pediatric Off indicated by 0 0 to 300 0 mL Neonate Resolution 0 01L Adult 1mL Pediatric 0 1 mL Neonate Accuracy 0 01 L of monitored exhaled tidal volume Adult 1 mL of monitored exhaled tidal volume Pediatric 0 1 mL of monitored exhaled tidal volume Neonate Defaults 0 00L Adult OmL Pediatric 0 0mL Neonate L2786 AVEA ventilator systems Chapter 7 Alarms and Indicators 7 11 Note The Low Exhaled Tidal Volume alarm will assert on a single occurrence of a low exhaled volume In patients who have variable tidal volumes the Low Exhaled Tidal Volume alarm may be turned off default and the Low Exhaled Minute Volume alarm can be used to avoid nuisance alarms High Tidal Volume High V This is a low priority audible visual alarm HIGH Vt is displayed and a low priority tone sounds if the absolute monitored exhaled tidal volume is greater than the High Tidal Volume threshold setting
39. Wye Performance Specifications Flow Range 0 0 002 to 30 L min Vol Accuracy 10 Flow Resistance 6 cmH20 20 L min Dead Space 0 8 mL Freq Response 16 Hz Calibration 36 point curve Linearity lt 2 Operating Temperature 5 to 40 C Physical Specifications Sensor length 1 68 Diameter Insp Vent Side 15 mm OD Diameter Exp Patient Side 15 mm OD Tube length N A Connector Pin amp Socket type Weight lt 10g not including wire Service Life 25 cycles Sterilization Steam Autoclave Materials Sensor Delrin Wire Platinum Screen Stainless Steel 304 or 316 Pin PhBz gold over nickel plated Spacer Delrin L2786 AVEA ventilator systems Appendix E Sensor Specifications amp Circuit Resistance E 3 Circuit Resistance Test The resistance of a neonatal patient circuit should be tested for proper functionality of the ventilator for neonatal patient size applications using ET tubes of 3 5 millimeter or greater on patients with lung compliances of 3 or greater Excessive circuit resistance under these circumstances may result in triggering a Circuit Occlusion Alarm This resistance test applies to all neonatal applications except nCPAP 1 To measure the resistance of the breathing circuit set up the system as follows Mode TCPL AC Flow Correction ATPD Set in utility screen configuration tab Rate 4 Inspiratory Pressure 10 cmH20 Peak Flow 15
40. alarm remains active for more than 5 seconds i e the circuit pressure does not return to PEEP 5 cmH20 within 5 seconds No breaths are delivered during this alarm condition The Safety and Exhalation valves open allowing the patient to breathe from room air and the Safety Valve alarm activates Bias flow is suspended while this alarm is active PEEP may not be maintained This alarm remains active flashing until the condition causing it has been resolved Low PEEP This is a high priority audible visual alarm LOW PEEP is displayed and a high priority tone sounds if the baseline pressure PEEP is less than the Low PEEP alarm threshold for a period greater than 0 25 0 05 seconds Range 0 to 60 cmH20 Defaults 3 cmH20 Adult Pediatric 1 cmH20 Neonate The alarm is off if set to Zero Circuit Occlusion Alarm This is a high priority audible visual alarm CIRCUIT OCCLUSION is displayed and a high priority tone sounds whenever the inspiratory or expiratory limb of the patient circuit becomes sufficiently occluded to trigger the alarm An inspiratory limb occlusion is unlikely to cause any pressure increase at the patient and will simply result in the termination of the breath The system is designed to prevent an expiratory limb occlusion from causing an increase in patient pressure measured at the distal end of the ET tube beyond the following limits e For Neonates 5 cmH20 or 15 whichever is greater above the target pressure
41. ammoria or mild soap 2 Wipe surfaces with a clean water dampened cloth before use Ensure that the sensor is clean and dry before use Maintenance Inspection and Testing An Extended System Test EST should be performed every time when cleaned components are re assembled for use to check for leaks Packaging Follow your institution s guidelines for packaging of material for sterilization Sterilization Only the following parts can be steam sterilized autoclave The Water Trap PN 50000 40035 the Infant Hot Wire Flow Sensor PN 16465 and Water Collection Jar PN 33985 Steam sterilization autoclave maximum temperature 138 degrees Celsius 280 degrees Fahrenheit minimum temperature 132 degrees Celsius 270 degrees Fahrenheit for a maximum of 18 minutes and a minimum of 15 minutes 30 cycles maximum number for any of these parts Vacuum Steam Cycle 3 pre condition pulses vacuum pulses Sterilizer vacuum target set to 10 26 psig Dwell at 132 138 degrees Celsius 270 to 280 degrees Fahrenheit for 4 to 8 minutes duration 50 cycles maximum for the hot wire infant flow sensor and 25 cycles maximum for the water trap water collection jar Drying following steam cycle Minimum dry time 15 minutes The Infant Hot Wire Flow Sensor part no 16465 may also be cold sterilized using a 2 4 glutaraldehyde solution Storage Temperature 20 to 60 degrees Celsius 4 to 140 degrees Fahrenheit Humidity 0 to 95 Relati
42. and Cleaning Cleaning and Sterilization The AVEA is designed for easy maintenance All exposed parts of the ventilator are corrosion resistant CAUTION DO NOT submerge the ventilator or pour cleaning liquids over or into the ventilator DO NOT sterilize the ventilator The internal components are not compatible with sterilization techniques DO NOT gas sterilize or steam autoclave adapters or connectors while attached to the tubing The tubing will over time take the shape of the adapter causing poor connection and possible leaks To minimize cleaning and replacement frequency the AVEA design places the exhalation manifold flow sensor and diaphragm behind the exhalation filter and water trap Limitations on Reprocessing There are instructions supplied by other manufacturers for individual parts and accessories that are included with the ventilator Follow those directions for processing between patients Instructions Point of Use Follow your institutions procedures for removing material from a patient area for processing Preparation for Decontamination There are no special requirements regarding Preparation for Decontamination for these parts Automated Cleaning Follow cleaning instructions below No specific automatic cleaning devices have been validated Manual Cleaning Cleaning External Surfaces All external surfaces of the ventilator the Exhalation cartridge included can be wiped clean with one of the
43. calculated and this parameter is displayed as 3 Fowler W S Lung Function Studies II The Respiratory Dead Space Am J Physiol 1948 154 405 416 4 Heller H K nen Bergmann M Schuster K D An Algebraic Solution to Dead Space Determination According to Fowler s Graphical Method Comput Biomed Res 1999 32 161 167 L2786 Appendix l Volumetric CO2 Calculations Operator s manual Anatomic Dead Space Tidal volume Ratio Vd ana Vt Anatomic dead space Tidal volume ratio is used to calculate the ratio of the tidal volume not participating in gas exchange wasted ventilation This is calculated on a breath to breath basis Vd phy Vt is probably more clinically relevant but requires an arterial blood sample to be accurate Alveolar Dead Space Alveolar dead space is mathematically the difference between physiological dead space and anatomical dead space It represents the volume of the respiratory zone that is from ventilation of relatively under perfused or non perfused alveoli Vaw V y phy d ana Alveolar Ventilation Va The minute volume of fresh gas that participates in gas exchange V 4 Rate V V phy Oxygenation Index Ol Oxygenation index is a dimensionless number often used to assess the pressure cost of oxygenation This parameter is calculated from the Fio mean airway pressure and an arterial blood oxygen measurement entered by the clinician FIO Paw 100 PaO
44. continuously updated unless the PRINT or FREEZE membrane button is pressed The PRINT button transfers data to a connected parallel printer The FREEZE button freezes the current screen and suspends the screen update until pressed a second time Table 4 1 Waveform Choices Heading Display Waveform Shown Paw cm H20 Airway Pressure Pinsp CMH20 Airway Pressure at Machine Outlet Pes cmH20 Esophageal Pressure Ptr cmH20 Tracheal Pressure Pip cmH20 Transpulmonary Pressure Flow L min Flow Vi ml Airway Tidal Volume Fexp Expiratory flow Finsp Inspiratory Flow PCO CO2 value through the respiratory cycle Analog 0 Based on analog input scale Analog 1 Based on analog input scale PCOz CO level through respiratory cycle Axis Ranges The scale vertical axis and sweep speed horizontal axis of the displayed graphs are also modifiable using the touch screen To change the displayed range press either axis of the displayed graph to highlight it The highlighted axis can then be modified using the data dial below the touch screen Figure 4 3 To accept the change touch the highlighted axis again or press Accept Time Ranges 0 to 6 seconds 0 to 12 seconds 0 to 30 seconds 0 to 60 seconds L2786 4 4 Chapter 4 Monitors Displays and Maneuvers Operator s manual Loops Accessing the Loops Screen SCREEN SELECT To access the loops screen press the screens MAIN LOOP MONITOR membra
45. criterion in pressure control ventilation Machine volume is circuit compliance compensated in adult and pediatric applications Range Normal 0 10 to2 50L Adult 25 to 500 ml Pediatric 2 0 to 300 0 m Neonate Defaults OL Adult 0 ml Pediatric 0 ml Neonate Once you set the machine volume the ventilator calculates the decelerating inspiratory flow required to deliver the Machine Volume in the set inspiratory time When a Pressure Control breath is delivered and Peak Flow decelerates to this calculated peak inspiratory flow if the Machine Volume has not been met the ventilator will automatically transition to a continuous flow until the Machine Volume has been delivered Once the set Machine Volume has been delivered the ventilator will cycle into exhalation When the Machine Volume is met or exceeded during delivery of the pressure control breath the ventilator will complete the breath as a normal Pressure Control breath During this transition in flow the Inspiratory Time will remain constant and the Peak Inspiratory Pressure will increase to reach the set Machine Volume The maximum Peak Inspiratory Pressure is determined by the High Peak Pressure alarm setting Note Pmax is disabled when Machine Volume is set In the event Flow Cycling is active in Pressure Control the ventilator will not Flow Cycle until the Machine Volume has been met Machine Volume must be set to zero to change patient size To set Machine Volume
46. during a mandatory inspiratory breath the maneuver will not commence until the ventilator cycles into exhalation and the minimum expiratory time of 150 msec has elapsed Alarms All currently available alarms shall be active during the MIP P1o9 maneuver except Apnea Interval and Low PEEP To Perform a MIP P100 Maneuver The MIP P100 maneuver allows the measurement of the Maximum Inspiratory Pressure MIP achieved by the patient during an expiratory hold maneuver The ventilator can also measure the P100 value which is the maximum inspiratory pressure achieved in the first 100 milliseconds of the maneuver From the Maneuvers Screen select MIP P100 The MIP maneuver screen allows the operator to set Duration This is the time period that ventilation is suspended to conduct the maneuver Once the Start button is depressed normal ventilation will be suspended until the Duration time period has elapsed or the operator presses the Stop button Sensitivity This sets the sensitivity threshold that the ventilator uses to begin the timer for the P100 maneuver The default position is three centimeters but can be adjusted by the operator to assure accuracy in patients with minimal inspiratory effort L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 13 Note The maneuver sensitivity setting is used for the maneuver only and does not affect trigger sensitivity Start Stop Starts and Stops the man
47. e Changing the set tidal volume while in Vsync e Reaching the Volume Limit setting Delivered tidal volume gt 1 5 times the set volume e Flow termination of the test breath e Exiting Standby e Activation of any of the following alarms High Peak Pressure Alarm Low Peak Alarm Low PEEP Alarm Patient Circuit Disconnect Alarm l Time Limit LE Limit Vsync is only available for adult and pediatric patients Note If flow cycling is active during a PRVC or Vsync breath flow cycling of the breath can only occur if the target tidal volume has been delivered This allows for expiratory synchrony while assuring delivered tidal volume Note The Peak Flow control sets the flow rate which is used by the ventilator for the test breath only The ventilator uses the Peak Flow setting and Inspiratory Pause to determine the maximum inspiratory time during Vsync ventilation Vsync Rise With Vsync active this control sets the slope of the pressure rise during the volume breath It is a relative control ranging from fast 1 to slow 9 Range 1to9 Default 5 PSV Rise This control sets the slope of the pressure rise during a pressure supported breath It is a relative control with a range from fast 1 to slow 9 Range 1to9 Default 5 3 46 Chapter 3 Ventilator Operation Operator s manual PSV Cycle Sets the percentage of peak inspiratory flow at which the inspiratory phase of a PSV breath is te
48. following Isopropyl Alcohol or Chlorine Compounds with a maximum concentration of 1 10 Cleaning Accessories and Parts ONLY the following three parts are cleanable using an enzyme pre soaking solution The Water Trap PN 50000 40035 the Infant Hot Wire Flow sensor PN 16465 and the Water Collection Jar PN 33985 1 Prepare an enzyme based pre soaking solution such as Klenzyme made by Steris Corporation Mentor OH or equivalent in accordance with manufacturer s instructions using sterile distilled water at 20 30 degrees Celsius 68 86 degrees Fahrenheit 2 Immerse the part to be cleaned in the prepared solution for 2 5 minutes making sure that all lumens and air pockets are completely filled with the solution and agitate periodically 3 Remove the part from the solution after 2 5 minutes and rinse immediately by immersing in at least 1 gallon of sterile distilled water at 20 30 degrees Celsius 68 86 degrees Fahrenheit Leave the part in the rinsing bath for at least 1 minute agitating periodically to ensure thorough rinsing L2786 8 2 Chapter 8 Maintenance and Cleaning Operator s manual 4 Visually inspect the part after removing it from the rinse to ensure that no debris remains on the part 5 Repeat the cleaning method if necessary Cleaning the outside of the Capnometry sensor and cable 1 Use a cloth dampened with 70 isopropyl alcohol 10 bleach solution disinfectant spray cleaner such as Steris Coverage SprayHB
49. in adult and pediatric applications with circuit compliance compensation active simply set the minimum desired tidal volume In neonatal applications with proximal flow sensor in use e Adjust the peak inspiratory pressure to reach the desired tidal volume e Select Vdel as one of the monitored parameters Read the Vdel uncorrected Tidal Volume delivered from the machine during a pressure control breath e Set the Machine volume to or slightly below the Vdel measurement This will set the machine volume to a level that will provide more consistent tidal volume delivery in the case of slight decreases in lung compliance Caution If a proximal flow sensor is used it must be attached at both the patient wye and at the ventilator connection to ensure proper function of the AVEA L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 43 L2786 Note To protect against larger changes in lung compliance the machine volume should be set higher and Volume Limit should be added Insp Rise The Inspiratory Rise setting controls the slope of the pressure rise during a mandatory breath This control is a relative control with fast being a setting of 1 and slow a setting of 9 Range 1to9 Default 5 The Inspiratory Rise control is not active for TCPL breaths Flow Cycle The flow cycle setting sets the percentage of the peak inspiratory flow Peak Flow at which the inspiratory phase of a Pressure Control TCPL o
50. is 5V or less select the 0 5 volt range Select the appropriate analog scale and press the ACCEPT key to enter the configuration Analog Input is configured on the same connector as the ILV The pin configuration for cables to use this feature is shown in Figure 2 36 below Pin configuration of the connector for attachment to your other device must be supplied by the manufacturer of that device WARNING given in Appendix A All applications using this connector require specially made cables DO NOT connect a standard DB25 cable to this receptacle This could result in damage to the ventilator Contact Technical Support at the numbers Analoa Inout Channel 1 OHOOYVOHOAABDS S A DOODOODHOVWVOYO Analoa Inout Channel 0 Figure 2 36 Analog Input connections 2 28 Chapter 2 Unpacking amp Setup Operator s manual Analog Outputs Set Analog Output Type The analog output flow signal can be selected between Wye Flow calculated flow to the patient or Machine Flow the flow measured by the inspiratory flow sensor within the ventilator Pressure Flow Volume Breath Phase OHOHOODOHNDADBeO S 00000000000 Figure 2 37 Analog Outputs Pin configuration The pin configuration for pressure flow volume and breath phase analog outputs is shown above Refer to Appendix B Specifications for Analog Output Pressure cmH2O mv flow L min mv and Volume ml mv conversions
51. key on the maneuver screen The ventilator will suspend normal ventilation and begin delivering the Maneuver Tidal Volume at the set Flow The corresponding Pressure Volume curve will be drawn by the ventilator as the volume is delivered to the patient Once complete the ventilator will automatically resume normal ventilation and Freeze the graphics display The maneuver can be aborted at anytime by pressing the Stop soft key If at anytime during the maneuver the ventilator detects a patient effort the ventilator will cycle into exhalation and normal ventilation will resume The measured Pflex Pflex Lwr Pflex Upr and Vdelta will be displayed if they can be determined At this point the operator can choose to accept the inflection points as determined by the ventilator or the operator can choose to set the inflection points manually To set the inflection points manually simply scroll the cursor to the desired position with the Data Dial and press the Set Pflex Lwr or Set Pflex Upr softkey The Vdelta will be automatically recalculated The measured data can be saved by pressing the Save Loop softkey Up to four loops may be saved when a fifth loop is saved the oldest loop and data will be erased L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 17 Note If the loop and corresponding data are not saved by the operator the data will be erased after exiting the maneuver screen AutoPEEP Maneuver Scre
52. message appears in the indicator at the upper right of the touch screen The alarm icons flash until the cause of the alarm is no longer present Both high and medium priority alarms that have been resolved will appear as a solid yellow message indicator with no icon displayed until the Alarm Reset button is pressed See Table 7 1 on page 7 12 for alarm messages Multiple alarms can be displayed simultaneously If 2 or more alarms are current a white triangle appears on the right of the alarm indicator message Touching the screen over the triangle will open a drop down box for display of up to nine alarm messages In the event that there are more than nine active or resolved alarms available for display the nine highest priority alarms will be displayed To close the drop down box and display a single alarm message touch the triangle again Alarm messages are prioritized in order of appearance the highest priority alarm is always displayed in the top position of the alarm indicator display The alarm indicator is solid green with no message when no alarms are currently active Backup Alarm advisory A continuous tone alarm sounds when a vent inop occurs and the Back Up Alarm electronics detects the primary alarm is not functioning L2786 AVEA ventilator systems Chapter 7 Alarms and Indicators 7 5 Alarm Controls Setting an Alarm Limit To set the limits for each alarm press the red Alarm a E LIMITS membrane button on
53. of it To turn off the reference loop freeze the screen again and press the Ref Loop On Off toggle button shown in Figure 4 8 L2786 4 6 Chapter 4 Monitors Displays and Maneuvers Operator s manual Maneuvers VOLUME A C 70 61 AutoPEEP 12 A B Leak L Total Ye 3 cmH20 PEEP a z 20 70 8 0 00 ADRK bpm m Lmin amp sec cmH20 Limin Rate Volume Peak Flow Insp Pause PEEP Flow Trig Fi02 Cale Ve LO70see 230sec Figure 4 9 Maneuver Selection The AVEA is capable of performing various respiratory mechanics maneuvers These maneuvers can be accessed from the screens menu and selecting the Maneuvers screen Depending on the model the following maneuvers may be available Esophageal MIP P100 Inflection Point Prex and AutoPEEPaw Each maneuver screen includes all controls monitors and waveform or loop graphics pertinent to the selected maneuver Note Maneuvers are not available for Neonate patients Some alarms may be disabled during a maneuver Note The initiation of an AutoPEEP or Pflex maneuver will terminate Apnea ventilation L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers Esophageal Maneuver Screen ESOPHAGEAL VOLUME A C RK joules WOBp RK joules WOBi 1 12 joules L OBv RK emH20 AutoPEEPes RK 2 2 Ree mLicmH20 aw omo Giwi Cow dPes i 20 hf 70 bt 8 f 0 00 I 3 Bt 1 0 Ji 21 i i hs
54. of the communications equipment Separation distance according to frequency of transmitter m Rated maximum output 150 kHz to 80 MHz 150 kHz to 80 MHz in 80 MHz to 800 MHz 80 MHz to 800 MHz power of transmitter outside ISM bands ISM bands WwW d m 1 16 F d m 1 20 F dm gF dm T 60NF 0 01 0 12 0 12 0 12 0 23 0 1 0 37 0 38 0 38 0 73 1 1 16 1 20 1 20 2 30 10 3 67 3 79 3 79 7 27 100 11 60 12 00 12 00 23 00 For transmitters rated at a maximum output power not listed above the recommended separation distance amp in metres m can be determined using the equation applicable to the frequency of the transmitter where F is the maximum output power rating of the transmitter in Watts W according to the transmitter manufacturer NOTE 1 At 80 MHz and 800 MHz the separation distance of the higher frequency range applies NOTE 2 The ISM industrial scientific and medical bands between 150 kHz and 80 MHz are 6 765 MHz to 6 795 MHz 13 553 MHz to 13 567 MHz 26 957 MHz to 27 283 MHz and 40 66 MHz to 40 70 MHz NOTE 3 An additional factor of 10 3 is used in calculating the recommended separation distance for transmitters in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2 5 GHz to decrease the likelihood that mobile portable communications equipment could cause interference if it is inadvertently brought into patient areas NOTE 4 These guidelines may not apply in a
55. on the settings during normal ventilation and can be set to any tidal volume desired independent of the current mode of ventilation Note The Tidal Volume setting during a Pflex maneuver is not circuit compliance compensated Flow This setting is adjustable from 0 5 to 5 l min and controls the inspiratory flow used to deliver the maneuver tidal volume PEEP The is the PEEP used for the Slow Flow Maneuver The operator can select any PEEP level independent of the control PEEP used during controlled ventilation PEEPTeq This control sets the equilibration at the Maneuver PEEP after which the Slow Flow Maneuver begins Sensitivity This sets the sensitivity threshold that the ventilator uses to detect patient effort during the Slow Flow Maneuver The default position is three centimeters but can be adjusted by the operator to assure accurate sensitivity in all applications Start Stop Starts and Stops the maneuver Note All maneuver control settings are independent of control settings in normal ventilation WARNING Normal ventilation is suspended for the duration of the maneuver The patient should be evaluated for contraindications prior to executing the maneuver The patient should be directly monitored by trained medical personnel during the maneuver To execute a Pflex maneuver set the Tidal Volume Flow Maneuver PEEP PEEP Equilibration time and Sensitivity Press the Start soft
56. rise MODE Waveform Vol Limit Flow cycle Flow Tmax Bias flow Tmax Pres trig PSV Bias flow PSV rise cycle PSV rise Cycle Bias flow Pres trig Bias flow cycle Pres trig PSV cycle Bias PSV cycle Pres trig Pres trig PSV Vol limit PSV Tmax flow PSV Flow T High Tmax when Bias flow Pres trig Tmax Cycle Sync Bias flow Vsync Pres trig Bias flow T High Pres trig ON Flow Flow Pres trig PSV Cycle Cycle T Low Demand Demand Sync Flow Flow Available only with Vsync activated for adult or pediatric patients only Available for adult and pediatric patients only L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 41 Advanced Settings Characteristics and Ranges L2786 Volume Limit Vol Limit The Vol Limit setting sets the volume limit for a Pressure Limited breath When the volume delivered to the patient meets or exceeds the preset Vol Limit the inspiratory phase of the breath is terminated Range Normal 0 10 to2 50L Adult 25 to 750 ml Pediatric 2 0 to 300 0 ml Neonate Defaults 2 50 L Adult 500 ml Pediatric 300 ml Neonate The Vol Limit setting sets the volume limit for a Pressure limited breath When the volume delivered to the patient meets or exceeds the preset Vol Limit the inspiratory phase of the breath is terminated Volume Limit is active for Pressure PRVC Vsync TCPL and PSV breaths only In neonatal applications Volume Limit requires the use of a wye f
57. systems Index A access the advanced settings group 3 39 active humidifier 2 11 adult patient circuit 2 11 advanced settings 3 39 accessing the screen 3 39 advanced settings indicator 3 39 bias flow 3 44 flow cycle 3 43 insp rise 3 43 machine volume 3 42 pres trig 3 44 PSV cycle 3 46 PSV rise 3 45 PSV Tmax 3 46 sigh 3 44 volume limit 3 41 Vsync 3 45 Vsync rise 3 45 waveform 3 43 air inlet pressure 4 22 D 2 air supply 2 1 alarm conditions 7 12 alarm indicator 7 4 alarm indicators 3 8 alarm limits 7 5 alarm loudness 2 22 alarm reset button 7 6 alarm silence 7 6 alarm types gt 7 6 alarms 7 4 apnea interval 7 11 extended high peak pressure 7 9 fan failure 7 7 high exhaled minute volume 7 10 high O2 percent 7 11 high peak pressure normal 7 8 high peak pressure sigh gt 7 8 high priority 7 4 high rate 7 11 high tidal volume 7 11 IE ratio 7 11 loss of air 7 7 loss of gas supply 7 7 loss of O2 7 7 L2786 low exhaled minute volume 7 9 low O2 percent 7 11 low peak pressure 7 8 low PEEP 7 9 low priority 7 4 maximum inspiratory time 7 11 medium priority 7 4 safety valve open 7 6 vent inop 7 6 annual maintenance 8 4 apnea backup CPAP or APRV BIPHASIC 3 27 apnea back up ventilation 3 16 Artificial Airway Compensation 3 11 assemble and insert the exhalation filter and water trap gt 2 3 asse
58. than 95 for three consecutive breaths If Loss of Gas or Not Ventilating alarms are active in addition to a Circuit Disconnect alarm the trigger for these alarms is a loss of system pressure not a circuit leak or circuit disconnect See Loss of Gas Supply on page 7 7 and Not Ventilating on page 7 6 for details and resolution of these conditions Note While the circuit disconnect alarm is active the ventilator will stop cycling and set a bias flow The ventilator will automatically detect the patient upon reconnection and resume normal ventilation The apnea interval timer is suspended during a Patient Circuit Disconnect Alarm Setting extremely small delivered tidal volumes with Circuit Compliance Compensation not active and using a proximal flow sensor may result in assertion of Patient Circuit Disconnect Alarms Gas Supply Indicators and Alarms L2786 Loss of Air This is a high priority audible visual alarm LOSS AIR is displayed and a high priority tone sounds This alarm is triggered if the wall air supply to the ventilator drops below 18 0 psig 1 2 bar and the ventilator does not have a functional internal compressor or the compressor output is insufficient to meet instrument demand The patient continues to be ventilated by the oxygen supply only Loss of O2 This is a high priority audible visual alarm LOSS O2 is displayed and a high priority tone sounds This alarm is triggered if t
59. the ventilator will increase above the current set Fidz Example If the Increase Fidz is set at 20 AND The set Fidz is 40 WHEN The increase Fio Maneuver is activated the Fic will increase to 60 for two minutes after which it will return to 40 The default setting for infants is 20 and 79 for Pediatric and Adult applications Note To achieve 100 delivered F102 during the Increase O2 maneuver set the Increase F102 setting to its maximum of 79 Note The settings will be reset to default values when New Patient is selected in the set up menu 2 26 Chapter 2 Unpacking amp Setup Operator s manual Input Output Tab VOLUME A C 8 9 Configuration L Vte Analog Input Scale 24 z vde bpm Rate 1 2 0 IE 69 cmH20 Ppeak 6 cmH20 PEEP 24 Bi 0 20 gt 20 bpm L a Limin Rate Volum Peak Flow 4 80 1 70sec UTILITY Input Output 0 00 sec Insp Pause Figure 2 35 Utility Screen Input Output Tab Monitoring Analog Output Type Wye Flow onore O eni f 21 4 Flow Trig Fi02 L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 27 Analog Input Configuration L2786 Under the heading Set Analog Input Scale there are two buttons representing two possible voltage ranges If the full scale output of the device you are interfacing with is less than 1 volt select the 0 1 volt scale button If it
60. the PSV level should be increased slightly 3 26 Chapter 3 Ventilator Operation Operator s manual Figure 3 18 PSV Waveform In Figure 3 18 breath number 1 represents the flow tracing which occurs when the PSV level is insufficient to meet the patient demand Breath two shows resolution after increasing the PSV level slightly Pressure tracing will show a similar appearance Non Invasive Ventilation The ventilator can perform non invasive ventilation with a standard dual limb circuit Leak compensation should be turned on when using this feature To turn leak compensation on use the touch screen control displayed in the Ventilator Set Up Screen Note Non invasive ventilation requires the use of a snug fitting mask with no bleed holes Excessive leaks around the mask may result in false triggering of the ventilator or assertion of disconnect alarms Apnea Backup Ventilation Apnea Backup Ventilation is available in Assist Control SIMV CPAP PSV and APRV BIPHASIC modes Apnea Backup in Assist Control or SIMV When in Assist Control or SIMV modes the apnea backup rate is determined by the operator set mandatory breath Rate or the Apnea Interval setting whichever provides the highest respiratory rate When the Apnea Interval setting found in the Alarm Limits window determines the backup rate the ventilator will continue to ventilate at this rate until the apnea has been resolved All other controls for apnea ventil
61. the internal battery has been i i depleted to a level that provides a minimum of two minutes of safe operation i LOSS AC i A high priority audible visual alarm is and LOSS AC POWER N A i High POWER _ displayed whenever the power switch is on and AC powerhas i been removed from the ventilator i e power cord disconnect or loss of supply power ILV _ A high priority audible visual alarm is activated and ILV NIA _ High DISCONNECT DISCONNECT displayed whenever the master ventilator L2786 7 14 Chapter 7 Alarms and Indicators Operator s manual Message Alarm Condition Range Priorit _ becomes disconnected from the slave ventilator during ILV INVALID GAS ID A medium priority audible visual alarm shall be activated and N A Medium _ INVALID GAS D shall be indicated whenever a defective gas _ LD connector is installed in the ventilator When a defective Gas _ LD connector is detected the gas corrections default to air FAN FAILURE A low priority audible visual alarm is activated and FAN FAILURE N A Low _ indicated whenever the fan has stopped rotating l High EtCO2 Low priority alarm if monitored EtCO2 exceeds the alarm 6 150 mmHg or off Low _ threshold setting _ Default 60 mmHg Low EtCO2 Low priority alarm if monitored EtCO2 does not exceed the alarm l 1 145 mmHg or off Low _ threshold setting Default 30 mmHg L2786 AVEA ventilator systems 8 1 Chapter 8 Maintenance
62. time press the FREEZE button and use the data dial to move the cursor through the time line The time line is shown as yellow text on the spreadsheet Event markers appear in green text Note Changing the date time back on the instrument s internal clock erases stored trend data 4 26 Chapter 4 Monitors Displays and Maneuvers Operator s manual Main Screen Displays Calculated I E Ratio The AVEA displays the calculated E Ratio Calc E based on the set breath rate set tidal volume and set peak flow for Volume breaths or the set breath rate and set inspiratory time for Pressure TCPL and PRVC breaths The display is located next to the Calculated Minute Volume display at the bottom left of the Main screen This display is updated while the data dial is being rotated when changing any of the primary patient settings that affect these displays in order to view the Calculated E Ratio that results when the setting change is accepted before accepting that change This display reverts to the previously established values if the setting change is cancelled or times out 0 28 sec 572 5 ar Sy Figure 4 20 Calculated I E Ratio Display Range 1 99 9 to 99 9 1 Limitations For Volume breaths the calculated E Ratio shall only change if the set tidal volume set breath rate or set peak flow is changed For Pressure TCPL PRVC breaths the calculated E Ratio shall only change if the set breath rate or set inspiratory t
63. 0 L Adult 1000 ml Pediatric i 300 0 ml Neonate Low Vt The absolute monitored exhaled tidal volume does not exceed the Off to 3 00 L Adult High _ Low Tidal Volume alarm threshold setting Off to 1000 mL Pediatric i l Off to 300 0 mL Neonate APNEA Active in A C SIMV APRV BIPHASIC and CPAP PSV modes if 6 to 60 seconds _ High INTERVAL the ventilator does not detect a breath within the preset APNEA Default 20 seconds time interval HIGH RATE _ The monitored total breath rate exceeds the set alarm RATE 1 to 200 bpm lt Medium Default 75 bpm I TIME LIMIT The inspiratory time for a breath exceeds the set MAX I TIME N A Low plus pause time which is 5 0 seconds for adult pediatric patients and 3 0 seconds for neonatal patients i 1 E LIMIT The inspiratory expiratory ratio for a mandatory breath exceeds Not active in APRV BIPHASIC mode Low _4 1 The inspiratory phase of the breath is terminated LOW Fio2 Delivered oxygen percentage falls below the set Fio2 minus 6 or N A High 18 Fid2 whichever is greater HIGH F102 Delivered oxygen percentage rises above the set Fidz plus 6 N A High CIRCUIT A high priority audible visual alarm is activated and CIRCUIT N A High DISCONNECT DISCONNECT displayed whenever the patient circuit becomes i disconnected from the ventilator or patient LOW BATTERY A high priority audible visual alarm is activated and LOW NA High BATTERY displayed whenever
64. 0 sec Insp Pause will be in effect for each Volume breath delivered cmH20 Pressure Support in centimeters 0 to 90 cmH20 Adult Pediatric 3 cmH20 or 10 whichever is greater PSV of water pressure 0 to 80 cmH20 Neonate cmH20 Positive end expiratory pressure 0 to 50 cmH20 2 cmH20 or 5 of setting whichever is greater PEEP in centimeters of water pressure L min Sets inspiratory flow trigger 0 1 to 20 0 L min 1 0 2 0 L min for PEEP lt 30 cmH20 Flow Trig point in liters per minute 2 0 3 0 L min for PEEP gt 30 cmH20 0 2 L min 10 of setting Wye flow sensor only Controls the percentage of 21 to 100 3 02 02 oxygen in the delivered gas cmH20 In APRV BIPHASIC mode 0 to 90 cm H20 3 cmH20 Pres High controls the baseline pressure achieved during Time High sec In APRV BIPHASIC mode sets 0 20 to 30 0 sec 0 1 sec Time High the minimum time for which the high pressure setting is maintained sec In APRV BIPHASIC mode sets 0 20 to 30 0 sec 0 1 sec Time Low the minimum time for which the low pressure setting is maintained cmH20 In APRV BIPHASIC mode 0 to 45 cmH20 2 cmH20 or 5 of setting whichever is greater PresLow controls the baseline pressure L2786 achieved during Time Low 3 34 Chapter 3 Ventilator Operation Operator s manual To activate a primary control press the touch screen directly over the control The control highlights changes color indicating that it is activ
65. 1 0 sec Limin Insp Pause Flow Trig Figure 2 39 Utility Screen Input Output Tab Generic RS 232 Output L2786 21 s Fi02 2 30 Chapter 2 Unpacking amp Setup Operator s manual VueLink RS 232 Output Select Off VOLUME A C SPENS 0 1 9 Configuration Input Output Date Time Monitoring L Vte Analog Input Scale Analog Output Type 24 3 5 Wye vde Flow bpm Rate RS 232 Output 20 0 00 6 1 0 21 s A s L a Limin sec cmH20 Limin Volume Peak Flow Insp Pause PEEP Flow Trig 0 1 70sec LEAI or VOXP Select VOXP and either 8 N 1 7 N 1 7 E 1 or 7 0 1 and Baud Rates of 9600 19200 38400 57600 115200 VOLUME A C oes 0 14 9 Configuration Input Output Date Time Monitoring L Vte Analog Input Scale Analog Output Type 24 0 1 5 Wye vde Flow bpm Rate RS 232 Output VOXP font owe 38400 24 0 20 20 0 00 6 1 0 21 C4 bpm L a Limin sec cmH20 Limin amp Rate Volume Peak Flow Insp Pause PEEP Flow Trig Fi02 alc Ve Lo 1 70sec 4 80 1 21 Figure 2 41 Utility Screen Input Output Tab VOXP RS 232 Output L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 31 Nurse Call Connection The AVEA can be connected to a remote nurse call system via the modular connector on the rear panel shown in Figure 2 25 E The jack is configured to interface with normally closed NC open on alarm or normally open NO closed on alar
66. 1 to 75 L min 0 4 to 30 0 L min 60 L min 20 L min 8 0 L min Inspiratory Time I Time Range Defaults Adult Pediatric Neonate Adult Pediatric Neonate The l Time control sets the inspiratory time cycle variable for all mandatory pressure TCPL or PRVC breaths Range 0 20 to 5 00 seconds 0 15 to 3 00 seconds Default 1 0 second 0 75 seconds 0 35 second Adult Pediatric Neonate Adult Pediatric Neonate Note If the preset I Time is greater than actual l Time as determined by V Fp and the waveform an Inspiratory Pause time equal to the preset I Time minus the actual l Time is added to the breath Inspiratory Pause Insp Pause Sets an Inspiratory Pause which will be in effect for each volume breath delivered A preset inspiratory pause will be delivered with each volume breath Range 0 00 to 3 00 seconds Default 0 00 second PSV Pressure Support The PSV control sets the pressure in the circuit during a pressure supported breath Range 0 to 90 cmH20 Adult Pediatric 0 to 80 cmH20 Neonate Maximum Flow gt 200 L min Adult lt 120 L min Pediatric lt 50 L min Neonate Default 0 cmH20 Note The ventilator will not allow the operator to set a Peak Inspiratory Pressure Insp Pres or PSV PEEP or baseline pressure in APRV BiPhasic greater than 90 cmH20 The ventilator will deliver an on screen Pop Up Message stating that the Ppeak gt 90 cmH20 T
67. 20 The ventilator will deliver an on screen Pop Up Message stating that the Ppeak gt 90 cmH20 The operator must change the Inspiratory Pressure and or PEEP setting to limit the Poeak to less than or equal to 90 cmH 0 3 38 Chapter 3 Ventilator Operation Operator s manual Inspiratory Flow Trigger Flow Trig The inspiratory trigger mechanism is activated when the Net Flow becomes greater than the Inspiratory Flow Trigger setting Net Flow is defined as Delivered Flow Exhaled Flow or Wye Inspiratory Flow when using a wye flow sensor When the Inspiratory Flow Trigger is enabled a low level of Bias Flow is delivered to the patient circuit during the exhalation phase of the breath Range 0 1 to 20 0 L min Defaults 1 0 L min Adult Pediatric 0 5 L min Neonate See also Pres Trig on 3 44 Caution If a proximal flow sensor is used it must be attached at both the patient wye and at the ventilator connection to ensure proper function of the AVEA Note To ensure adequate bias flow for inspiratory triggering the bias flow setting should be at least 0 5 liters per minute greater than the flow trigger threshold 02 The O2 control sets the percentage of oxygen in the delivered gas Range 21 to 100 Default 40 Note During Heliox administration the 02 control sets the percent of Oxygen in the delivered gas The balance of the delivered gas is Helium Pressure High Pres High Th
68. 20 Default 3 0 cmH20 L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 15 Start Stop The maneuver shall begin when the START key is actuated The maneuver shall be immediately terminated when the STOP key is actuated a patient effort is detected or the maneuver tidal volume has been delivered and normal ventilation will resume Note The initiation of a Pflex Maneuver is delayed by two factors The total delay is equal to 25 of the breath interval plus the PEEP Equilibration time set The PEEP Equilibration time has a range of 0 30 seconds If the mandatory breath rate is 10 bpm the breath interval is therefore 6 seconds and the delay to initiate Pflex is 1 5 seconds plus the PEEP equilibration time set At the default PEEP Equilibration time of 1 second the total delay is 2 5 seconds in this example If the mandatory breath rate is set to 1 bpm the breath interval is 60 seconds and the delay to initiate Pflex in this worst case scenario is 15 seconds plus the PEEP Equilibration time Upper Piiex and Lower Piiex determination Once the maneuver tidal volume has been delivered the ventilator will cycle into exhalation At the end of exhalation the Paw Vol loop will freeze automatically the upper and lower inflection points as well as the delta Prex volume will be calculated and displayed The ventilator will return to normal ventilation at the current ventilator settings The user can should th
69. 38400 15 0 35 1 0 21 Ca cmH20 amp sec cmH20 Limin A Insp Pres Insp Time Flow Trig Fi02 0 35sec The ventilator has two RS 232 ports installed for bi directional communication of data RS 232 Ch1 is currently used for software updates as well as data communications to external systems L2786 B 8 Appendix B Specifications Operator s manual VOXP Communications Requirements Communication is established between a ventilator and an external system with a properly configured set of system level items from physical cables adapters and communication parameters to application protocols A detailed description of the interface is available in a separate specification Consolidated VOXP Specification part number L3058 Revision A or later To ensure proper operation of the ventilator there is an important limitation to the implementation of the interface with external devices Waveforms should not be selected at baud rate settings less than 57600 and no more than 3 waveforms should be selected at baud rates of 57600 and higher Waveform transmission requires high speed communications and problems can occur if waveforms are requested at lower baud rates or if too many waveforms are requested at high baud rates WARNING To ensure proper operation of the ventilator external device communications using waveforms must follow the recommendations in Consolidated VOXP Specification part number L3058 Revision A or later T
70. 4 bar Inlet Fitting CGA DISS type body No 1240 NIST fitting per BS 5682 1984 O2 also available 2 2 Chapter 2 Unpacking amp Setup Operator s manual Assembling the Ventilator Assemble your AVEA ventilator s wheeled base using the instructions included in the package The ventilator body is easily attached to the base by means of four thumbscrews Reference the AVEA Service Manual Installation Instructions for detailed directions Figure 2 1 Standard Ventilator Base Figure 2 1 Basic and Comprehensive base attachment CAUTION The ventilator body and UIM weigh approximately 80 Ibs 36 4 kg Employ safe lifting procedures when assembling the ventilator L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 3 External battery option If you have purchased the optional external battery pack reference AVEA Service Manual Installation Instructions Install your external batteries per the installation instructions enclosed with the cart accessories kit P N 11372 Setting Up the Front of the Ventilator Assembling the Exhalation Filter and Water Trap To assemble and insert the exhalation filter and water trap do the following Screw the supplied water collection bottle into the threaded cuff of the water trap Figure 2 2 Attaching the Collection Bottle to the Water Trap Push the exhalation filter into the water trap assembly top as shown Locating Ridge for assembly in
71. AVEA Ventilator Systems Operator s Manual CardinalHealth Operator s manual 2008 Cardinal Health All rights reserved No part of this document may be reproduced stored or transmitted in any form or by any means without the written permission of Cardinal Health except as specifically permitted under the copyright laws of the United States of America AVEA and Capnostat are registered trademarks of the Cardinal Health group of companies Microsoft and Windows are registered trademarks or trademarks of Microsoft Corporation in the United States and other countries Other brands and their products are trademarks of their respective holders and should be noted as such USA Authorized European Cardinal Health Representative Respiratory Technologies Cardinal Health Germany 234 GmbH 1100 Bird Center Drive Leibnizstrasse 7 Palm Springs California 92262 8099 97204 Hoechberg Germany 800 231 2466 tel 49 931 4972 0 tel 1 714 283 2228 tel 49 931 4972 423 fax 1 714 283 8493 fax cardinalhealth com viasys Literature number L2786 Revision E L2786 AVEA ventilator systems Revision History Date Revision Pages Changes September 2005 A All Release May 2006 B 1 1 1 4 2 7 2 10 Removed references to the Plus model 2 12 Removed non operational from figure 2 19 3 16 3 18 3 21 3 33 Added a note regarding the setting of Peak 3 34 3 35 Inspiratory Pressure 5 3 Added Pp
72. AVEA ventilator systems Chapter 6 Infant NCPAP 6 5 Note Low Nasal CPAP Pressurz and High Nasal CPAP Pressure Alarm Thresholds are updated automatically when a new value is accepted in the nCPAP Primary Control Figure 6 6 nCPAP Primary Controls and Alarm Threshold Indicators CAUTION Apnea back up ventilation is suspended during nCPAP AVEA continually displays the following message during nCPAP administration Non Invasive Support APNEA Backup Disabled Figure 6 7 Caution Message Display Monitors L2786 In Nasal CPAP all existing monitors will be suspended except Air Inlet Pressure Air Inlet Oxygen Inlet O2 Inlet Gas Composition Monitor F102 Percent Leak The following monitors have been added for Nasal CPAP nCPAP level mean airway pressure Range 0 to 120 cmH20 Resolution 1cmH20 Accuracy 3 5 of reading or 2 cmH20 whichever is greater CPAP Flow mean inspiratory flow Range 0 300 LPM Resolution 0 1 LPM Accuracy 10 6 6 Chapter 6 Infant NCPAP Operator s manual Graphics All existing waves will be maintained except for the volume Vt wave will be selectable with no functionality and the loops selection button will be disabled Displayed Waves Net Flow Flow Range Minimum 2 to 2 LPM Maximum 300 to 300 LPM Default 40 to 40 LPM Inspiratory Flow CPAP Flow Finsp Range Minimum 2 to 2 LPM Maximum 300 to 300
73. Alarms ALARM LIMITS bpm mL High Rate Low Vte High Vte mmHg mmHg Low EtCO2 High EtCO2 Figure 5 7 Capnometry Alarms High EtCO Creates a low priority alarm if the monitored EtCO2 exceeds this setting see the previous figure Range 6 to 150 mmHg 0 8 20 kPa or Off Resolution 1 mmHg 0 1 kPa Default 60 mmHg 8 kPa Note The High EtCOz alarm must be set at least 5 mmHg 0 7 kPa above the Low EtCOz alarm setting Low EtCO L2786 Creates a low priority alarm if the monitored EtCO gt does not exceed the setting see the previous figure Range 1 145 mmHg 0 1 19 3 kPa or Off Resolution 1 mmHg 0 1 kPa Default 30 mmHg 4 kPa Note The Low EtCOz alarm must be set at least 5 mmHg 0 7 kPa below the High EtCO gt alarm setting 5 10 Chapter 5 Volumetric Capnography Operator s manual Maneuvers Several additional physiologic parameters Vd Vt phy Vd phy Vd alv VA Ol and PF may be calculated by obtaining PaCO and PAO values at the same time as exhaled CO2 and volume measurements 1 Immediately before drawing an arterial blood sample press the Event button and select Arterial Blood Gas Event Softkey Figure 5 8 Event Softkey Volume and CO data from the preceding period set VCO2 Averaging time are stored WARNING The patient s cardio respiratory status should be stable before performing the capnography calculations to ensure the most acc
74. CPAP setting gt 3 cmH20 Set nCPAP level 1 cmH20 if nCPAP setting lt 3 cmH20 nCPAP Pressure Limit A high priority audible visual alarm will be activated if the nasal CPAP pressure exceeds 11 cmH20 for 3 seconds Upon activation of the alarm the safety valve will open to ambient The alarm will deactivate and the safety valve will close when the nCPAP pressure falls below 4 5 cmH20 L2786 AVEA ventilator systems Chapter 6 Infant NCPAP 6 3 Initiating Nasal CPAP 1 To initiate Nasal CPAP touch the Modes membrane button on the UIM or touch the screen area for the Current Mode Display The Mode Select box appears MODE SELECT Volume Pressure AIC A C Volume Pressure SIMY SIMY Mode Accept Figure 6 1 Mode selection 2 Touch Nasal CPAP The following message appears CALIBRATION REQUIRED DISCONNECT Patient DISCONNECT Expiratory Limb of Circuit at Wye NCPAP Device Must Remain Attached at Wye and Open to Ambient Press Continue Cont Cancel Figure 6 2 Calibration Required Message 3 Disconnect the Nasal CPAP device from the patient and disconnect the expiratory limb of the circuit at the patient wye Figure 6 3 Disconnect Here For Testing y Figure 6 3 Disconnect Point for Calibration Do not disconnect the Nasal CPAP device at the wye and leave the prongs open to ambient L2786 6 4 Chapter 6 Infant NCPAP Operator s manual 4 Touch Continue the following message appears
75. CT RESUME CURRENT Figure 3 4 Patient Select Screen If you press the Resume Current key the ventilator begins ventilation at the most recent patient settings The New Patient key clears loops and trend buffers and resets all settings to default values Press Patient Accept to accept your selection L2786 3 10 Chapter 3 Ventilator Operation Operator s manual Patient Size Select Screen The Patient Size Select screen appears as the first step of the new patient setup sequence Note The new patient size selection will not be active until the on screen SETUP ACCEPT button is pressed PATIENT SIZE SELECT NEO PED ADULT SIZE ACCEPT Figure 3 5 Patient Size Selection Screen Note The ventilator will not allow patient size changes when the active mode of ventilation is not available in the new patient size selection The ventilator will display a message instructing you to first change the ventilation mode For example in neonatal ventilation with TCPL active you cannot change to a pediatric or adult patient size without first changing the mode to one available for those patients L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 11 Ventilation Setup Ventilation Setup Screen L2786 VOLUME A C 6915 11 Cire Comp 0 Setup Leak ji 1 00 gt 15 Vt mL L Total Ve 3 cmH20 PEEP C Rate Ronan Peak Fi Plow Insp Pause BEEP Elec Trig Calc V
76. D with real time graphic displays and digital monitoring capabilities a touch screen for easy interaction membrane keys and a dial for changing settings and operating parameters A precision gas delivery engine with servo controlled active inhalation and exhalation improves performance over previous generations The AVEA has been designed to function using most commonly available accessories It is easy to clean and its design does not allow liquids to pool on the casing reducing the likelihood of fluid leakage into the body of the ventilator There are two models of AVEA Comprehensive and Standard The following table shows the standard and optional functions available with each model Functions amp Accessories Standard Comprehensive Modes Proximal Hot Wire Flow Sensing Synchronized Nebulizer 24 Hour Trending Internal Battery Full Color Graphics Display Loops and Waveforms Standard Cart X XI Xd i K amp i j Proximal Variable Orifice flow sensing Proximal Airway Pressure Monitoring Tracheal Catheter Esophageal Balloon Internal Compressor KXAN We Wee Heliox Delivery L2786 1 2 Chapter 1 Introduction Operator s manual Optional Functions amp Accessories Standard Comprehensive Custom Cart Option Included External Battery on custom cart only Option Option Gas Tank Holder on either cart Option Option
77. EA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 19 Capnometry Screen VOLUME AIC CAPNOMETRY 1 2 L Total Ve Rk mL min RK mmHg 21 i62 00 00 00 00 00 0 0 7 00 00 00 00 00 0 0 i A 0 0 cmH20 ee Pa ee Figure 4 15 Capnometry Screen in Maneuvers Selection Note See Chapter 5 Volumetric Capnography Tracheal Catheter Placement L2786 Some advanced mechanics measurements on the AVEA require the use of a tracheal catheter To ensure accuracy of measurements and to minimize risk of adverse events the tracheal catheter should be placed in the endotracheal tube and not extend beyond the tip To assure proper placement measure the length of the endotracheal tube and its associated adapters Insert the tracheal catheter into the endotracheal tube to a distance not greater than this measurement WARNING Inserting the tracheal catheter beyond the tip of the endotracheal tube may cause irritation and inflammation of the trachea and airways or produce vagal responses in some patients 4 20 Chapter 4 Monitors Displays and Maneuvers Operator s manual Digital Displays R N MAIN LOOP MONITOR The Monitor Screen To access the monitor screen press the Screens membrane button to the left of the touch screen on the TRENDS MANEUVER STANDBY UIM The button is labeled with the icon shown here AA fsoreens or UTILITY International English
78. Liquide oxygen fittings are also available from Cardinal Health Attaching the Gas Hoses Oxygen Connection Attach the Oxygen hose to the fitting on the right of the back panel Figure 2 29 Figure 2 29 Connecting the O2 Hose Heliox Connection If you have the upgrade for Heliox delivery attach the Heliox hose to the tethered Smart connector fitting on the left of the back panel as shown in Figure 2 30 The air hose will not attach to the fitting designed for Heliox and vice versa Figure 2 30 Connecting the Heliox Hose L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 21 WARNING Allow 90 seconds for the accumulator to purge before initiating patient ventilation with Heliox gas WARNING Connection of a gas supply at the Helium Oxygen mixture inlet that does not contain 20 oxygen can cause hypoxia or death Although an 80 20 mixture of Helium and Oxygen is marketed as medical grade gas the Helium Oxygen gas mixture is not labeled for any specific medical use Attaching the Air Hose Attach the Air supply hose to the Smart connector fitting with the integral water trap filter on the left of the back panel as shown in Figure 2 31 The fitting shown here is a DISS fitting Fittings which accept NIST and Air Liquide hoses are also available from Cardinal Health The air hose will not attach to the fitting designed for Heliox and vice versa
79. OBiunc is calculated using esophageal pressure when the baseline esophageal pressure PEEP s is greater than the esophageal pressure Pes indicating patient effort Work of the chest wall WOBew for a spontaneously breathing patient is calculated using only the portion of the total tidal volume delivered due to a patient effort Vp and the chest wall compliance Ccw Range 0 00 to 20 00 Joules L Resolution 0 01 Joules L Accuracy 10 Note Requires an esophageal balloon catheter L2786 G 8 Appendix G Advanced Pulmonary Mechanics Monitored Parameters Operator s manual Imposed Work of Breathing WOB Imposed Work of Breathing WOB is defined as the work performed by the patient to breathe spontaneously through the breathing apparatus i e the E T tube the breathing circuit and the demand flow system Imposed work is assessed by integrating the change in tracheal pressure and tidal volume and normalizing the integrated value to the total inspiratory tidal volume Vii Requires the use of an optional tracheal catheter Based on the following formula WOBI PEEPaw Pre a o dt where PEEPaw airway baseline pressure Ptr tracheal pressure Vii inspired tidal volume Range 0 00 to 20 00 Joules L Resolution 0 01 Joules L Accuracy 10 Note Requires a tracheal catheter L2786 AVEA ventilator systems H 1 Appendix H Capnometry Troubleshooting Error Message
80. ON hz Pt Weight Figure 3 8 Setup Screen EST Button 0 0 mLicmH20 Cire Comp HUMIDIFIER Active On From the Setup screen press the EST button Setup Accept A message will appear instructing you to remove the patient and block the patient wye After confirming that the patient is disconnected and the circuit wye blocked press Continue Cont The ventilator begins the EST and displays a countdown clock During the EST the ventilator will perform A Patient circuit leak test A Patient circuit compliance measurement A two point calibration of the oxygen sensor The patient circuit compliance measurement and leak test are performed simultaneously with the oxygen sensor calibration The maximum time for the EST is 90 seconds To restart the EST at any time press Cancel to return to the set up screen After each test is complete the ventilator will display a Passed or Failed message next to the corresponding test The SET UP ACCEPT key must be pressed in order for the AVEA to retain the circuit compliance measurement At this point even after power cycling off if SAME PT is selected the circuit compliance measurement will continue to be retained If NEW PT is selected the EST will be required to use this feature EXTENDED SYSTEM TEST Leak Test PASSED Circuit Compliance Test PASSED O2 Sensor Calibration IN PROGRESS 45 sec cance EXTENDED SYSTEM TEST Leak
81. Paw Ppeak aw PEEPaw Range 120 to 120 cmH20 Resolution 1 cmH20 Accuracy 2cmH20 or 5 whichever is greater Delta Esophageal Pressure dP s Delta Esophageal Pressure dPes is the difference between peak esophageal pressure Ppeak es and baseline esophageal pressure PEEP s dPes Ppeak es PEEPes Range 120 to 120 cmH20 Resolution 1 cmH20 Accuracy 2cmH20 or 5 whichever is greater AutoPEEPaw AutoPEEPaw is the airway pressure at the end of an expiratory hold maneuver Range 0 to 50 cmH20 Resolution 1 cmH20 Accuracy 2cmH20 or 5 whichever is greater Note Requires a passive patient L2786 AVEA ventilator systems Appendix G Advanced Pulmonary Mechanics Monitored Parameters G 5 Delta AutoPEEPaw dAutoPEEPaw Delta AutoPEEPaw dAutoPEEPaw is the difference between airway pressure at the end of an expiratory hold maneuver and the airway pressure at the start of the next scheduled breath after the expiratory hold maneuver Range 0 to 50 cmH20 Resolution 1 cmH20 Note Requires a passive patient Accuracy 2cmH20 or 5 whichever is greater AutoPEEPes AutoPEEPes is defined as the difference between esophageal pressure measured at the end of exhalation PEEPes minus the esophageal pressure measured at the start of a patient initiated breath Pes start and the sensitivity of the ventilator s demand system The sensitivity of the ventilator s demand sy
82. Pressure Support Ventilation L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 33 Primary Breath Controls The Primary Breath Controls are the operator set controls which directly affect the way a breath is delivered to your patient They are displayed along the bottom of the AVEA LCD touch screen Only the active controls for the selected mode of ventilation will be displayed Table 3 3 Primary Breath Controls Displayed Description Range Accuracy Control bpm Breath rate shown in Breaths 1 to 150 bpm Neo Pediatric 1 bpm Rate per Minute 1 to 120 bpm Adult ml Tidal Volume in milliliters 0 10 to 2 50 L Adult 0 2 ml 10 of setting Volume 25 to 500 ml Pediatric 2 0 to 300 ml Neonate cmH20 Inspiratory Pressure in 0 to 90 cmH20 Adult Pediatric Adult Pediatric 5cmH20 or 10 whichever is Insp Pres centimeters of water pressure 0 to 80 cmH20 Neonate greater Neonate 3 cmH20 for pressures lt 60 cmH20 and 10 for pressures gt 60 cmH20 measured at the patient wye end inspiratory pressure after 0 3 seconds L min Peak Inspiratory Flow in Liters 3 to 150 L min Adult 10 of setting or 0 2 L min 10 of setting Peak Flow per Minute 1 to 75 L min Pediatric whichever is greater 0 4 to 30 0 L min Neonate sec Inspiratory Time in Seconds 0 20 to 5 00 sec 0 10 sec Insp Time Adult Pediatric 0 15 to 3 00 sec Neonate sec Sets an inspiratory pause which 0 0 to 3 0 sec 0 1
83. SV Rise PSV Cycle and PSV Tmax are active even if the PSV level is set to Zero L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 47 Independent Lung Ventilation ILV L2786 Independent lung ventilation allows 2 ventilators to be synchronized to the same breath rate the rate control set on the master ventilator while all other primary and advanced controls for each ventilator can be set independently Master and slave ventilators need not operate in the same mode during ILV The AVEA offers a port to allow Independent Lung Ventilation ILV This connection is located on the rear panel C The output provides a 5 VDC logic signal synchronized to the breath phase of the master ventilator A specially configured accessory cable kit part number 16246 available from Cardinal Health is required to implement ILV WARNING Do NOT attempt to connect a standard DB 25 cable to this receptacle This could cause damage to the ventilator A specially configured cable is required for ALL features associated with this connector Contact Technical Support To enable Independent Lung Ventilation refer to Chapter 2 Ventilator Setup Independent Lung Ventilation ILV Note During ILV the alarm limits for each ventilator should be set to appropriate levels for each ventilator to assure appropriate patient protection Confirm apnea timer settings and apnea ventilation settings for the Slave ven
84. Test ASS D Circuit Compliance Test PASSED O2 Sensor Calibration PASSED Figure 3 9 Extended Systems Test Screens Once the test is complete press Continue to return to the set up screen L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 15 Note If the ventilator is NOT connected to an oxygen supply the O2 Sensor Calibration will immediately fail CAUTION Although failure of any of the above tests will not prevent the ventilator from functioning it should be checked to make sure it is operating correctly before use on a patient Setting the Ventilation Breath Type and Mode To access the Mode selection options press the Mode membrane button to the left of the LCD screen MODE SELECT Volume Pressure PRVC AIC AIC AIC Volume Pressure PRVC SIMV SIMV SIMV APRV CPAP MODE BiPhasic PSV ACCEPT Figure 3 10 Adult and Pediatric Mode Select Screen MODE SELECT Volume Pressure TCPL AIC AIC AIC Volume Pressure TCPL SIMV SIMV SIMV CPAP MODE PSV ACCEPT Figure 3 11 Infant Mode Select Screen without nCPAP L2786 3 16 Chapter 3 Ventilator Operation Operator s manual TCPL AIC MODE SELECT Volume Pressure AIC AIC Pressure Mode Accept Figure 3 12 Infant Mode Select Screen with nCPAP The choices displayed in the Mode Select screen are a combination of breath type and ventilation delivery mode e g a Volume limited breath with Assist Control v
85. a patient care activity which can be stored in the trend buffer FI The rate at which gas is delivered Measured in liters per ow minute L min Indicators A visual element showing operational status L Liters A unit of volume LED Light Emitting Diode L min Liters per minute A unit of flow Mode An operating state of the ventilator that determines the allowable breath types Monitored Parameter A measured value displayed in the monitor window O2 Oxygen Patient Breathing Circuit The tubing that provides the ventilatory interface between the patient and ventilator Paw Airway Pressure Measured in cmH20O PEEP Positive End Expiratory Pressure Pressure maintained in the circuit at the end of exhalation Peak Inspiratory Pressure Shows the highest circuit Ppeak pressure to occur during inspiration The display is updated at the end of inspiration Ppeak is not updated for spontaneous breaths K 2 Appendix K Glossary Operator s manual Plateau Pressure Measured during an Inspiratory Hold Pplat maneuver or during zero flow in a pressure control breath Used to calculate Static Compliance Cstat PSIG Pounds per square inch gauge 1 PSIG 07bar A Volume Controlled machine breath having a tidal Sigh Breath volume equal to one and a half times 150 of the current tidal volume setting WOB Patient Work of Breathing i e a measure of Patient Effort L2786 AVEA ventilator
86. abiaieees 4 1 Digital Display S n ernaint aTa EA sb tte sh E E T 4 20 Main Screen Displays nsionisonstimn napunan a a a a R A 4 26 Chapter 5 Volumetric Capnography sssssssssssssrssnunsnnnnnunnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnan 5 1 Theory of Operation sisii aiaa 5 1 DOLUP o EEP EA AT E E T E A EE SETAA T 5 2 Settings and Monitored Values s sssrssssrsssrrnssrenurenunnnsunnnnnnenunnnunnnnnenunnnennenunnannunenunnnnnnnnnennnenennnnnnnne 5 5 Alarms aai side oad aera ia aiaa a e ia a a aani 5 9 Ma e versS aaan eiiiai aii a a E E aaa 5 10 Zeroing th CAPNOSTA To ssciiisasaistuinsctinhiveaninioio a A T A a T 5 12 Checking the Accuracy of the CAPNOSTAT 5 ssssssssssssssstesssesnssesesseessessseessesssesseeesseessseeseneesensees 5 14 L2786 vi Operator s manual Chapter 6 Infant NOPAP inmin 6 1 OVOIVIOW Aiii aan a ariaa aa a aaa naaa aaa aaa aaa aai oaa aia aAa aR 6 1 CCIE COMA EDIT sisiiissusscisasutsi ieia iiiaae i aie 6 1 General Specifications ccsiicccssssssssccesserssecusvbedsciviesdesnerstisessonstesd iueveceststeruasiosscnsssssestbedastinestuserataiseaceets 6 1 Initiating Nasal CRAP inp iiine na AA a a ai 6 3 Monitors annaa aaa aaia a aidaa aa aanika daaa anida Sabada naa daaa viitssdssnitieadesbusdeiiasacdsoraticviztes 6 5 ETT o 111 EEA E E E T A E TAA E EE 6 6 Chapter 7 Alarms and Indicators scsssssssesssessssessssssessssecsenseensenseeseeeenenees 7 1 Status Indicators sine cavscaeins ica ssc ie dedSisi
87. ams 4 25 spreadsheet 4 25 trends screen 4 25 V variable orifice sensor 2 15 ventilation modes 3 21 ventilator specifications B 1 ventilator synchronization 2 23 visual alarm display 7 4 volume breaths 3 17 volume limit 3 18 3 41 Vsync 3 45 pressure control breaths 3 45 volume test breath 3 45 L2786 AVEA ventilator systems Index 5 Vsync rise 3 45 waveform 3 36 3 43 4 2 4 3 4 28 Vt 3 33 choices 4 3 waveforms colors 4 1 w freeze 4 3 l freezing 4 1 warnings x warranty iv main screen 4 1 water collection bottle 2 3 deat oe water trap 2 3 2 4 8 1 p 9 L2786 Index 6 Index Operator s manual This page intentionally left blank L2786
88. ange 140 to 140 cmH20 140 to 140 cmH20 Calibration EEPROM 29 Point Curve 29 Point Curve Linearity lt 1 between points lt 1 between points Operating Temperature 5 to 40 C 5 to 40 C 41 to 104 F Physical Specifications Connector ABS Sensor Length 1 36 in 3 5 cm 2 45 in 6 2 cm Diameter Insp Vent Side 15 mm OD 15 mm OD Diameter Exp Patient 15 mm OD 15 mm OD Tube Length 48 in 121 9 cm 73 in 185 4 cm Connector Bicore Proprietary Bicore Proprietary Weight 22 g 0 7 oz 31 g 1 0 oz Service Life Single Patient Use Single Patient Use Sterilization NA NA Material Sensor Lexan Sensor Lexan Flap Mylar Flap Mylar Tubing PVC Tubing PVC Connector ABS L min Dry air at 77 F 25 C and 14 7 psig barometric pressure Includes 1 for linearity and hysteresis with no zero drift for the pressure transducer and 2 for temperature and humidity variations The sensor must be corrected for barometric pressure and oxygen concentration Frequency Response is signal attenuation to 0 707 input and assumes 100 Hz sample rate E 2 Appendix E Sensor Specifications amp Circuit Resistance Operator s manual Hot Wire Flow Sensor Specifications Table E 2 Hot wire sensor specifications Part Number 51000 40081 Type Multiple use heated wire Circuit Location
89. ard size female conical connector Resistance to Flow Less than 1 0 cmH20 at 60 L min when new Flow leakage Less than 0 01 L min at 140 cmH20 internal pressure Size 9 7 cm diameter 33 cm tall 3 8 inches diameter 13 inches tall Plastic material Polystyrene Internal volume Approximately 500 mL Compliance Less than 0 5 mL cmH20 Condensate Water Trap capacity Approximately 130 mL up to Maximum Fill Line L2786 AVEA ventilator systems C 1 Appendix C Pneumatic Diagram Gas Delivery Engine The Gas Delivery Engine receives and conditions supplied Oxygen and Air from external and or internal compressor sources It then mixes the gas to the concentration required and delivers the desired flow or pressure to the patient The Gas Delivery Engine begins with the Inlet Pneumatics The Inlet Pneumatics accepts clean Oz or Air it provides extra filtration and regulates air and O2 gas before entering the Oxygen Blender The Oxygen Blender mixes the gases to the desired concentration before reaching the Flow Control Valve The Flow Control Valve controls the flow rate of the gas mixture to the patient Between the Oxygen Blender and Flow Control Valve the Accumulator System is installed to provide peak flow capacity The Flow Sensor provides information about the actual inspiratory flow for closed loop servo control The gas is then delivered to the patient through the Safety Rel
90. arm 7 6 displayed value 3 34 dynamic compliance 4 22 D 2 E electromagnetic components viii Enable Disable O2 Alarms 2 22 esophageal balloon 2 17 connection 2 17 event log 4 24 event markers 4 24 events 4 24 events automatically recorded 4 24 exhalation filter gt 2 3 2 4 2 5 8 1 exhaled tidal volume D 1 adjusted for ideal body weight D 1 expiratory Time 4 21 D 2 expired tidal volume 4 21 adjusted for patient weight 4 21 external battery 2 32 8 6 external water trap 2 19 F flashing alarms 7 4 flow cycle 3 43 flow trig 3 33 freezing a loop 4 5 freezing the loops screen 4 5 fuses 8 9 G gas line pressure 2 1 gas sources 2 1 air supply 2 1 oxygen supply 2 1 graphs 4 3 H Heliox connection 2 20 heliox delivery 1 4 high priority alarm 7 4 hot wire sensor 2 13 humidification 1 4 2 11 3 13 l independent lung ventilation 2 23 2 24 3 47 indicators 7 1 external battery 7 1 internal battery 7 1 mains AC 7 1 inhaled tidal volume D 1 adjusted for ideal body weight D 1 insp pause 3 33 insp pres 3 33 insp rise 3 43 insp time 3 33 inspiratory pause 3 36 inspiratory pressure 3 35 inspiratory time 3 36 4 21 D 2 Inspiratory Expiratory ratio 4 21 D 2 inspired tidal volume 4 21 adjusted for patient weight 4 21 internal battery 2 32 8 6 L leak compensation 3 12 loops colors 4 1 compar
91. assive humidifier or HME is per Figure 2 17 The inspiratory limb of the patient circuit connects directly to the gas output of the ventilator The passive humidification system should be placed in line in the patient circuit per the manufacturer s instructions Figure 2 17 Adult Patient Circuit without active humidifier L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 11 Neonatal Patient Circuit The Neonatal Patient Circuit is attached as shown in Figure 2 18 Inspiratory Limb of Patient Circuit Figure 2 18 Neonatal Patient Circuit Front Panel Connections Figure 2 19 AVEA Front Panel Configurations Standard amp Comprehensive L2786 Chapter 2 Unpacking amp Setup Operator s manual Attaching Flow Sensors The AVEA can accept either a hot wire or a variable orifice proximal flow sensor These are in addition to the instrument s internal inspiratory flow sensor and heated expiratory flow sensor Three proximal flow sensors are available for the AVEA The standard Hot Wire flow sensor is suitable for neonatal and pediatric applications where the peak inspiratory flow rate is less than 30 L min This flow sensor is not active in adult applications Hot Wire Flow Sensor Retractable plastic A Hot Wire flow sensor attaches to the receptacle collar circled in light blue directly b
92. ation in Assist Control and SIMV are set when the primary control values for these modes are selected Apnea ventilation will terminate when one of the following criteria are met e The patient initiates a spontaneous breath e A manual breath is delivered e The mandatory respiratory rate is increased above the apnea interval setting Note The apnea interval timer is suspended during a Patient Circuit Disconnect Alarm L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 27 Apnea Backup in CPAP PSV or APRV BIPHASIC When CPAP PSV or APRV BIPHASIC is selected you MUST 1 Set the primary and advanced settings for CPAP PSV or APRV BIPHASIC 2 Select the breath type for APNEA backup mode Volume or Pressure in adult and pediatric patients or Volume Pressure or TCPL in neonatal patients by pressing the Apnea Settings key 3 Set the primary and advanced controls appearing at the bottom of the touch screen for the selected apnea breath type before pressing the MODE ACCEPT button The controls for apnea backup ventilation will not be visible once the MODE ACCEPT button has been pressed Only the controls that are active and required for CPAP PSV or APRV BIPHASIC will remain See Figure 3 19 to Figure 3 22 for Apnea backup settings available in each mode VOLUME A C Pressure AIC CPAP PSV 60 40 20 0 2 Sec 20 1 bpm l l min Rate Volume Peak How Fee Confirm Apnea Settings Figu
93. ation will still provide an elevated airway pressure to compensate for the resistance of the endotracheal tube When turned on the Artificial Airway Compensation AAC indicator will appear on the touch screen in all modes of ventilation even though Artificial Airway Compensation may not be active in the current mode i e in volume controlled breaths This is to alert you to the fact that Artificial Airway Compensation is turned on and will become active if a Pressure Support mode or a combination mode i e Volume Control SIMV is selected Tube Diameter Range 2 0 to 10 0 mm Default 7 5 mm Adult 5 5 mm Pediatric 3 0 mm Neonate Tube length Range 2 0 to 30 0cm Adult 2 0 to 26 0cm Pediatric 2 0 to 15 0cm Neonate Default 30 0 cm Adult 26 0 cm Pediatric 15 0 cm Neonate Leak Compensation LEAK COMP Range ON OFF Default OFF During exhalation PEEP is maintained by the cooperation of the Flow Control Valve FCV and the Exhalation Valve ExV The ExV pressure servo is set to a target pressure of PEEP and the FCV pressure servo is set to a pressure target of PEEP 0 4 cmH20 The ExV servo relieves when the pressure is above its target and the FCV supplies flow when the pressure drops below its target up to a maximum flow rate for the patient size It is not active during breath delivery Circuit Compliance When Circuit Compliance is active the volume of gas delivered during a volume controlled or targeted b
94. ator from a wall air source the external water trap is placed in line between the air hose and the smart air connector To attach align the connector assembly Figure 2 27 seat gently onto the fitting and screw down the fitting collar until finger tight Similar connectors for Air with NIST and Smart Connector Air Liquide fittings are also available from Cardinal Health Figure 2 27 Attaching the Air smart connector with water trap L2786 2 20 Chapter 2 Unpacking amp Setup Operator s manual The Smart Heliox Fitting A DISS type No 1180 smart connector fitting is also available for use with an 80 20 Heliox gas mixture Figure 2 28 Follow the instructions contained with your Heliox kit to install the tethered Heliox connector This fitting has no integral water trap filter All AVEA Smart connectors with or without the integral water trap filter attach in the same way Align the connector Figure 2 27 and Figure 2 28 seat gently onto the fitting and screw down the fitting collar until finger tight 20 80 PSIG 138 552 kPa in Flow 80 LPM Tether Figure 2 28 Attaching the Tethered Heliox Connector The AVEA Smart connectors signal to the ventilator which type of fitting is attached and therefore which gas controls to initiate The fitting on the right of the panel is for attaching the Oxygen gas source The O fitting type is CGA DISS type No 1240 NIST or Air
95. battery There is an internal battery supplied with the ventilator which will operate the ventilator for short periods see Chapter 8 Maintenance and Cleaning CAUTION The ventilator should be connected to a mains AC power supply for at least 4 hours prior to switching to internal battery power For operation on external battery the ventilator should be connected to a mains AC power supply for at least 12 hours with green LED lot to insure a fully charged battery Pressurized Oxygen Air or Heliox Gases The compressed gas sources must provide clean dry medical grade gas at a line pressure of 20 to 80 PSIG 1 4 to 5 6 bar Air or Heliox Supply Pressure Range 20 to 80 psig 1 4 to 5 5 bar Supply Air 20 to 80 psig 1 4 to 5 5 bar Supply Heliox 80 20 Heliox Only 3 to 10 psig 0 2 to 0 7 bar Compressor Air Temperature 5 to 40 C 41 to 104 F Minimum Flow 80 L min at 20 psig 1 4 bar Air Inlet fitting CGA DISS type body No 1160 Air NIST fitting per BS 5682 1984 Air also available Heliox Inlet fitting CGA DISS type body No 1180 Heliox Note NIST fittings for air and oxygen are available from Cardinal Health upon request at the time of the order Oxygen Supply Pressure Range 20 to 80 psig 1 4 to 5 5 bar Supply Oxygen Temperature 5 to 40 C 41 to 104 F Humidity Dew Point of gas should be 1 7 C 3 F below the ambient temperature minimum Minimum Flow 80 L min at 20 psig 1
96. bulizer tubing to the fitting at the bottom of the front panel as shown here The fitting is marked with the icon shown here Figure 2 22 Attaching nebulizer tubing Note To use the internal nebulizer the AVEA must be connected to a high pressure air source The nebulizer is not active while the AVEA is operating on its internal compressor The ventilator incorporates an internal pneumatic compressor which creates the drive pressure necessary to operate the nebulizer Note The nebulizer requires an inspiratory flow rate of at least 15 liters per minute to activate and is flow compensated to maintain set tidal volumes CAUTION When the internal nebulizer is used the ventilator decreases the flow rate by 6 L min to compensate for the nebulizer output However since flow from the internal nebulizer can vary using the internal nebulizer may impact the tidal volumes delivered to the patient Note Do not operate the nebulizer while using Heliox 2 16 Chapter 2 Unpacking amp Setup Operator s manual Attaching a Proximal Pressure Sensor A proximal pressure sensor to monitor proximal airway pressure can be attached to the Comprehensive model of AVEA On the Comprehensive AVEA the connector is labeled as Aux as shown in Figure 2 23 and is circled in purple When active this feature will display amp alarm to proximal airway pressures j Aux Figure 2 23 Proximal pressure sensor connect
97. ced sending screen data to printer Printer Out of Paper Print Screen button was pressed printer reported it is out of paper Printer Offline Print Screen button was pressed printer is not available Printer Error Print Screen button was pressed printer reported an error condition Printer Ready Sending screen data to printer has completed L2786 F 2 Appendix F AVEA Message Bar Text Operator s manual AVEA MESSAGE BAR TEXT CAUSE Printer Busy Print Screen button was pressed device has not completed sending data from previous activation Volume Limit disabled On disconnect of WFS Neo or Hotwire when Size is NEO and Volume Limit is active Proximal Flow Sensor disconnected On disconnect of WFS any type Flow sensor is not Heliox compatible On connect of Hotwire WFS when Heliox is active Proximal Airway Line disconnected On disconnect of Proximal Pressure connection Proximal Flow Sensor conflict On simultaneous connect of Hotwire and VarFlex WFS Esophageal monitoring not available On connect of Esophageal Balloon when size is NEO Tracheal monitoring not available On connect of Tracheal Catheter when size is NEO Flow Sensor Error On power up failure to validate any internal flow sensor Wye Sensor Error On connect and failure to validate any proximal flow sensor Dev
98. cent to the data dial Vte Kg Vti Vti Kg Spon Selection Menu for Monitored Parameter Highlighted Parameter XF lpm Figure 4 22 Selectable Monitored Parameters Displayed on the Main Screen Note The main screen monitored parameters may be different than the monitored parameters on the loops or trends screens L2786 AVEA ventilator systems 5 1 Chapter 5 Volumetric Capnography Introduction The Volumetric Capnography Vco2 Option for AVEA adds new monitoring and advanced calculation features The option requires purchase of the sensor and a software activation In addition to traditional ETCO2 and capnography there are features that assist the clinician with patient evaluation Warnings Periodically check the CO2 sensor for excessive moisture or secretion build up Volumetric capnography measurements require accurate measurement of delivered volumes For this reason a proximal flow sensor or circuit compliance compensation must be used Furthermore when circuit compliance compensation is used and if the circuit compliance changes volumetric accuracy will be altered A system leak such as that caused by un cuffed endotracheal tubes may affect flow related readings These include flow pressure dead space CO gt production and other respiratory mechanics parameters Nitrous oxide excessive levels of oxygen helium and halogenated hydrocarbons can influence the CO2 measurem
99. corner of the mode indicator BLUE tracings represent the expiratory phase of a mandatory assisted or spontaneous breath A GREEN tracing during the expiratory phase of a single breath indicates that a purge of the expiratory flow sensor or the wye flow sensor if attached has occurred A PURPLE tracing indicates safety state which occurs when the safety valve is open Waveforms L2786 Three waveforms can be selected and simultaneously displayed on the MAIN screen as shown in Figure 4 1 Note Waveforms are circuit compliance compensated for pediatric and adult patient sizes Waveform Heading Display Flow l min Vt ml Figure 4 1 Waveform Graphs Displayed on the Main Screen Chapter 4 Monitors Displays and Maneuvers Operator s manual When you press and highlight the waveform heading display on the touch screen a scrollable menu appears showing the choice of waveforms Figure 4 2 Waveform Selection Menu Highlighted Waveform Heading Y axis of graph V ml X axis of graph 4 6 8 10 12 250 Figure 4 2 Waveform Selection To scroll through the waveform choices turn the data dial under the touch screen To make your selection touch the touch screen menu again or press the Accept membrane button shown here next to the data dial ACCEPT CANCEL Figure 4 3 Data dial L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 3 Each waveform is
100. ctric shock To avoid electrical shock plug the power cord into a properly wired receptacle use only the power cord supplied with the ventilator and make sure the power cord is in good condition WARNING If the integrity of the external power earth conductor arrangement is in doubt unplug the ventilator from the mains AC and operate it from its internal battery or the optional external battery L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 33 User Verification Test WARNING The User Verification Test should always be performed off patient The User Verification Test consists of the three following sub tests and should be performed before connection to a new patient The POST test The POST or Power On Self Test is transparent to the user and will only message if the ventilator encounters an error Normal ventilation commences at the culmination of the POST e The Extended Systems Test EST During this test the ventilator will perform Patient circuit leak testing Patient circuit compliance measurement Two point calibration of the oxygen sensor e The Alarms Test consisting of verification for High Ppeak alarm High O2 alarm Ext High Ppeak Alarm Low Ppeak alarm Low Ve alarm Loss of AC alarm High Ve alarm Circuit Disconnect High Vt alarm High Rate Alarm Low Ozalarm Apnea Interval alarm Low Vt alarm Low PEEP alarm CAUTION Alt
101. culations sssssssesssesssssenssesessenseanssacecaes l 1 Appendix J Electromagnetic Declarations s sssssssssssnsresnnsnnnnnnnsnnnnnnnnnnnnnnnnnns J 1 Append Ko Glossary ana a aa ceceetts K 1 NJERA E aa a eames 1 viii Operator s manual Notices EMC Notice This equipment generates uses and can radiate radio frequency RF energy If this equipment is not installed and used in accordance with the instructions in this manual electromagnetic interference may result This equipment has been tested and found to comply with the limits of acceptance set forth in Standard EN 60601 1 2 for Medical Products These limits provide reasonable protection against electromagnetic interference EMC when operated in the intended use environments described in this manual This ventilator is also designed and manufactured to comply with the safety requirements of Standard EN 60601 1 IEC 60601 2 12 CAN CSA C22 2 No 601 1 M90 and UL 2601 1 This ventilator can be affected by portable and mobile RF communications equipment This ventilator should not be stacked with other equipment The following cables were used in the evaluation of this ventilator e 15619 Normally Open Patient Call Cable Length 1 7 meters e 15620 Normally Closed Patient Call Cable Length 1 7 meters e 70600 Cable Communications Length 1 meter e 70693 Cable Communications Length 3 meters e Standard Centronix Printer Cable Length 2 meter
102. d Space Vd phy Range 0 999 mL Resolution 0 1 mL or three significant digits whichever is greater L2786 5 8 Chapter 5 Volumetric Capnography Operator s manual Physiologic Dead Space Tidal Volume Ratio Vd Vt phy Range 0 99 Resolution 1 Alveolar Dead Space Vd alv Range 0 999 mL Resolution 0 1 mL or three significant digits whichever is greater Oxygenation Index Ol Oxygenation index is a dimensionless number often used to assess the pressure cost of oxygenation Ol Range 0 200 when PAO2 is entered in mmHg OI Range 0 1500 when PAO2 is entered in kPa Resolution 0 1 or three significant digits whichever is greater PaO Fio Ratio P F The PAO gt 2 F102 ratio is a simple assessment of gas exchange Range 0 800 PAO2 entered in mmHg 0 106 Paoz entered in kPa Resolution 0 1 or three significant digits whichever is greater Waveforms and Loops PCO wave capnogram Displays the CO2 value through the respiratory cycle as measured and reported by the COs sensor at the wye Maximum range 0 150 mmHg 0 20 kPa PCO Vte loop Displays the patient s exhaled CQ gt value on the vertical axis and exhaled Vt on the horizontal axis During the inspiratory phase both values will be set to zero Maximum range CO2 0 150 mmHg 0 20 kPa Maximum range Vte 0 2 5 liters L2786 AVEA ventilator systems Chapter 5 Volumetric Capnography 5 9
103. d separation distance for transmitters in these frequency ranges Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed FR transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the AVEA Ventilator is used exceeds the applicable RF compliance level above the AVEA Ventilator should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the AVEA Ventilator Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m L2786 J 4 Appendix J Electromagnetic Declarations Operator s manual 60601 1 2 IEC 2001 E Table 205 Recommended separation distance between portable and mobile RF communications equipment and the AVEA Ventilator The AVEA Ventilator is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the AVEA Ventilator can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the AVEA Ventilator as recommended below according to the maximum output power
104. d tidal volume VTi is measured by the O0to4L 20ml 10 of reading Adult machine inspiratory flow sensor inside the ventilator and sensor reflects the volume without compensating for tubing 1 ml 10 of reading Neonate wye compliance It is a calculation of the difference sensor between the flow delivered and the flow exhaled during inspiration When using a proximal flow sensor the VTi is measured as the inspiratory flow translated into volume goes to the patient at the point of insertion of the sensor between the patient interface and the wye Vtilkg Inspired tidal volume adjusted for patient weight 0 to 4 ml kg Spon Vt Spontaneous tidal volume A zero 0 Spont Vt 0to4L 20ml 10 of reading Adult machine indicates the most recent breath was not a sensor spontaneous breath It is an instantaneous value 1 ml 10 of reading Neonate wye sensor Spon Vt kg Spontaneous tidal volume adjusted for patient 0 to 4 ml kg weight Mand Vt Mandatory tidal volume Displayed as a rolling O0to4L 20ml 10 of reading Adult machine average of either 8 breaths or one minute sensor whichever occurs first 4 1 ml 10 of reading Neonate wye sensor Mand Vt kg Mandatory tidal volume adjusted for patient weight 0 to 4 ml kg Derived Vdel Total delivered machine volume measured by the 0 to 4L 20ml 10 of reading ventilator s inspiratory flow sensor This value will be greater than the VTi if tubing compliance compensation is ac
105. ded expiratory filter Replace expiratory filter L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 43 Symptom Low NCPAP Pressure High NCPAP Pressure Circuit Disconnect Inaccurate barometric pressure reading L2786 Solution s Check circuit Check patient interface Problem Circuit disconnect Circuit leak Patient interface leak Patient circuit occlusion Water in circuit Check patient circuit Check nasal prongs Patient interaction Patient circuit disconnect Check patient circuit Call Cardinal Health Technical Support Barometer could require calibration Chapter 2 Unpacking amp Setup Operator s manual This page intentionally left blank L2786 AVEA ventilator systems 3 1 Chapter 3 Ventilator Operation Membrane Buttons and LEDs Figure 3 1a User Interface Module International Showing Button Icons L2786 Chapter 3 Ventilator Operation Operator s manual Figure 3 1b User Interface Module English Showing Button Labels Figure 3 1 User Interface Module The Membrane buttons are the UIM controls which surround the Touch Screen Moving clockwise around the UIM from the top right see arrow they are Alarm Silence LED Pressing this button will disable the audible portion of an alarm for 2 minutes 1 second or until the Alarm Silence button is pressed again This button is not functional for a VENT INOP alarm Note Pressing the ala
106. dicators Operator s manual O Alarms Low 02 Low Fi02 This is a high priority audible visual alarm LOW Fi0 is displayed and a high priority tone sounds if the monitored Delivered O2 falls below the set FlO2 minus 6 or 18 F102 whichever is greater High 02 High Fi02 This is a high priority audible visual alarm HIGH F102 is displayed and a high priority tone sounds if the monitored Delivered O2 rises above the set FiO 6 Table 7 1 Alarm Conditions Message Alarm Condition Range SAFETY VALVE _ Safety valve is open NIA High OPEN VENT INOP Ventilator failure due to a recoverable or non recoverable NIA High condition The safety valve opens indicated by a SAFETY VALVE message and the patient is allowed to breathe room air PEEP is _ hot maintained LOSS AIR Wall air drops below 18 0 psig 1 2 bar and no functional N A High _ compressor is installed or the compressor output is insufficient to i meet instrument demand Patient will continue to be ventilated by _ Oe supply only i LOSS 02 _ Oxygen supply to the ventilator drops below 18 0 psig 1 2 bar N A lt High and the Oz is set to gt 21 Patient will continue to be ventilated by the air supply only i LOSS HELIOX The alarm is triggered if heliox is being used and the heliox gas N A High supply to the ventilator drops below 18 0 psig 1 2 bar The i patient continues to be ventilated by the oxyg
107. e CmH20 Insp Pres Figure 3 26 Highlighted Control To modify the settings for the highlighted control turn the data dial below the touch screen Figure 3 27 Turning ina clockwise direction increases the selected value turning counterclockwise decreases it E ACCEPT CANCEL Figure 3 27 Data dial To accept the displayed value either press the touch screen directly over the highlighted control or press the ACCEPT membrane button to the left of the data dial The control color will change back to normal and the ventilator will begin operating with the new setting If you press the CANCEL button or do not actively accept the new setting within 15 seconds ventilation will continue at the previous settings L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 35 Descriptions of Primary Breath Controls Breath Rate Rate The breath rate control sets the breath interval Its function is dependent upon the selected mode of ventilation and it has different effects on the breath cycle depending on which mode is selected Range 1 to 150 bpm Neonate Pediatric 1 to 120 bpm Adult Breath Interval 60 Rate sec Defaults 12 bpm Adult 12 bpm Pediatric 20 bpm Neonate Tidal Volume Volume A volume breath delivers a predetermined volume of gas to the patient Tidal Volume together with the Insp Flow and Waveform settings determine how the volume breath is delivered Range 0 10 to 2 50L Adult 25 to
108. e Time Low Pressure Low Time Demand Breath Q Spontaneous Breath triggers change to Pressure High Spontaneous Breath triggers change to Pressure Low Figure 3 16 APRV BIPHASIC Mode L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 25 L2786 Continuous Positive Airway Pressure CPAP Pressure Support Ventilation PSV Pressure Demand Breath Figure 3 17 CPAP Waveform In CPAP PSV mode all breaths are patient initiated demand breaths unless the MANUAL BREATH key is pressed or apnea backup ventilation is activated When the MANUAL BREATH key is pressed a single breath is delivered at the currently selected apnea backup control settings Pressure Support is active in CPAP mode see Demand Breaths on page 3 19 CAUTION When CPAP PSV is selected you must 1 Select the breath type for APNEA backup mode AND 2 Set the primary controls visible at the bottom of the touch screen for the selected apnea breath type before pressing the MODE ACCEPT button The controls for the apnea breath type will not be visible once the MODE ACCEPT button has been pressed Only those controls that are active and required for CPAP PSV will remain To review the settings for Apnea backup ventilation open the mode window and select Apnea Settings Note IF PSV level is insufficient to meet patient demand premature termination of the breath may occur with auto cycling In these cases
109. e For Adults Pediatrics 10 cmH20 or 15 whichever is greater above the target pressure Target pressure set PEEP set Inspiratory Pressure Bias flow is suspended while the alarm is active and the alarm is deactivated when the occlusion is removed Note High patient circuit resistance may cause false circuit occlusion alarms False circuit occlusion alarms may also occur when peak inspiratory flow exceeds 150 L min for adult 75 L min for pediatrics and 30 L min for neonates For the recommended test for neonatal circuit resistance refer to Appendix E Sensor Specifications amp Circuit Resistance on page E 1 The alarm is not active in nCPAP mode 7 10 Chapter 7 Alarms and Indicators Operator s manual Volume Alarms Low Exhaled Minute Volume Low Ve This is a high priority audible visual alarm LOW MINUTE VOLUME is displayed and a high priority tone sounds whenever the monitored exhaled minute volume is less than the Low Exhaled Minute Volume threshold setting Range Off indicated by 0 1 to 50 L Adult Off indicated by 0 0 1 to 30 0L Pediatric Off indicated by 0 0 01 to 5 00 L Neonate Defaults 1 00 Liter Adults 0 50 Liter Pediatrics 0 05 Liter Neonate High Exhaled Minute Volume High Ve This is a medium priority audible visual alarm HIGH MINUTE VOLUME is displayed and a medium priority tone sounds whenever the monitored exhaled minute volume is greater than the High Exhaled Minute
110. e L Oy fas igure 3 6 Ventilation Screen In the Setup screen controls are available to set the following Artificial Airway Compensation AAC Range ON OFF Default OFF When Artificial Airway Compensation is turned on the ventilator automatically calculates the pressure drop across the endotracheal tube and adjusts the airway pressure to deliver the set inspiratory pressure to the distal carina end of the endotracheal tube This calculation takes into account flow gas composition Heliox or Nitrogen Oxygen Fraction of Inspired Oxygen F102 tube diameter length and pharyngeal curvature based on patient size Neonatal Pediatric Adult This compensation only occurs during inspiration Artificial Airway Compensation is active in all Pressure Support and Flow Cycled Pressure Control Breaths Note Monitored airway pressures inspiratory will be higher than set values when Artificial Airway Compensation is active WARNING Activation of Artificial Airway Compensation while ventilating a patient will cause a sudden increase in the peak airway pressures and a resultant increase in tidal volume Exercise caution when activating Artificial Airway Compensation while the patient is attached to the ventilator to minimize the risk of excessive tidal volume delivery 3 12 Chapter 3 Ventilator Operation Operator s manual Even if inspiratory pressure is set at zero Artificial Airway Compens
111. e adjusted for patient weight Vti kg ml Spontaneous tidal volume exhaled Spon Vte ml Kg Spontaneous tidal volume adjusted for patient weight exhaled Spon Vte Kg ml Mandatory tidal volume exhaled Mand Vte ml kg Mandatory tidal volume adjusted for patient weight exhaled Mand Vte Kg Vdel This is the uncorrected tidal volume measured by the inspiratory flow sensor inside the ventilator Leak Percent leakage L Minute Volume Total Ve ml kg Minute volume adjusted for patient weight Total Velkg L Spontaneous minute volume Spon Ve ml kg Spontaneous minute volume adjusted for patient weight Spon Velkg bpm Total Breath Rate spontaneous and mandatory Rate bpm Spontaneous breath rate Spon Rate bpm Mandatory Breath Rate Mand Rate sec Inspiratory time Ti sec Expiratory Time Te I E Inspiratory expiratory ratio B Min L Rapid shallow breathing index fit cmH20 Peak inspiratory pressure Ppeak L2786 4 22 Chapter 4 Monitors Displays and Maneuvers Operator s manual Display Value cmH20 Mean inspiratory pressure Pmean cmH20 Plateau pressure Pplat Pip Plat The ventilator is capable of calculating and displaying the Transpulmonary pressure during an inspiratory hold which is the difference between the airway plateau pressure Ppiat aw and the corresponding esophageal pressure cmH20 Positive end expiratory pressure PEEP Pbaro Barometric press
112. e batteries to re charge When the battery voltage becomes large enough to power the battery monitor the battery status indicators will display Failure to charge If the internal batteries do not show significant recharge after being reconnected to an AC power source for four hours contact your technical support representative as shown in Appendix A to arrange for replacement Total time to recharge depends on the extent of battery depletion and ventilator usage while charging is taking place Note The batteries in a ventilator that is not in use and not connected to AC will continue to slowly discharge A fully charged battery may reach a deep discharge state due to self discharge However even with a fully charged battery if the ventilator is unplugged from AC for more than 4 hours the internal battery status indicator will display red indicating a low battery condition In this condition the ventilator should be plugged into an AC outlet for 10 12 minutes to restore the battery to the correct charge state 8 8 Chapter 8 Maintenance and Cleaning Operator s manual Fuses The AVEA has the following replaceable fuses associated with internal DC external DC and AC power sources WARNING Do not remove or replace fuses or perform any maintenance tasks on the ventilator while your patient is connected Always perform these tasks off patient Battery Fuses The internal and optional external batte
113. e connected to a main A C supply and charged for at least 4 hours prior to switching to battery power External Battery 22 0 to 26 4 VDC Under normal operating conditions fully charged external and internal batteries combined are capable of powering the ventilator and compressor for a period of time equal to or greater than 2 hours and the ventilator alone for a period of time equal to or greater than 7 hours With a discharged battery the ventilator should be connected to a main AC supply and charged for at least 12 hours to insure a full charge Data Input Output Independent Lung Ventilation ILV The ventilator provides an output master and an input slave for synchronization of ventilators The output supplies a 5 VDC logic signal synchronized to the breath phase of the master via a 25 pin connector on the rear of the ventilator The pin configuration for this connector is as follows PIN FUNCTION 1 Analog Input Channel 0 14 Analog Input Channel 1 18 ILV In 6 ILV Out 20 Factory Use Only DO NOT CONNECT 22 Analog Output PRESSURE 23 Analog Output FLOW 24 Analog Output VOLUME 25 Analog Output BREATH PHASE 5 9 10 11 12 13 Ground Analog Note At least one analog ground is required for safe and accurate signal output and input One analog ground is sufficient for any and all of the other signals L2786 AVEA ventilator systems Appendix B Specifications B 3 A
114. e message bar will indicate a message stating that patient effort was detected Controls Tidal Volume Volume This is the volume of gas delivered to the patient during the maneuver Range Resolution Default Peak Flow 0 10 to 2 50 L Adult 25 to 500 mL Pediatric 0 01L Adult 1 mL Pediatric 0 25L Adult 25mL Pediatric Sets the Peak Flow used for the maneuver Note A square wave flow pattern is used for the maneuver Range 0 5 to 5 0 LPM Resolution 0 1 LPM Default 1 0 LPM Maneuver PEEP PEEP The Maneuver PEEP determines the baseline pressure at which the maneuver begins Note The Maneuver PEEP can be set independent of the PEEP used during normal ventilation Range 0 to 50 cmH20 Resolution 1 cmH20 Default 0 cmH20 PEEP Equilibration Time PEEP Teq Sensitivity The PEEP Equilibration Time determines the amount of time allowed for equilibration of the airway pressure before slow flow commences Upon activation of the maneuver the ventilator will set PEEP to the Maneuver PEEP level for the PEEP Equilibration Time prior to beginning the slow flow maneuver Range 0 0 to 30 0 seconds Resolution 0 1 second Default 1 0 second The preset Sensitivity establishes the level below the peak airway pressure that the pressure must drop to abort the Pre maneuver Note The Pflex maneuver will be terminated if a leak greater than 100 is present Range 0 1 to 5 0 cmH20 Resolution 0 1 cmH
115. eak to less than or equal to 90 cmH 0 WARNING Total resistance of the inspiratory and expiratory limbs of the breathing circuit with accessories should not exceed 4cmH 0 at 5 L min if inspiratory flows gt 15 liters per minute are used in TCPL ventilation modes For instructions on how to perform a circuit resistance test see Appendix E Sensor Specifications amp Circuit Resistance 4 Pressure Regulated Volume Control PRVC breaths are pressure breaths where the pressure level is automatically modulated to achieve a preset volume PRVC breaths are e Controlled by pressure inspiratory PEEP and volume e Limited by pressure inspiratory PEEP margin e Cycled by time or flow PRVC breath operation is as follows When PRVC is selected a decelerating flow volume controlled test breath to the set tidal volume with a 40 msec pause is delivered to the patient The demand system is active during this test breath The ventilator sets the target pressure at the end inspiratory pressure of the test breath for the first pressure control breath The next breath and all subsequent breaths are delivered as pressure control breaths The inspiratory pressure is based on the dynamic compliance of the previous breath and the set tidal volume Inspiratory pressure is adjusted automatically by the ventilator to maintain the target volume The maximum step change between two consecutive breaths is 3 centime
116. eak to the list of alert messages December 2006 C 2 31 Updated the Primary Controls table 2 36 Added NCPAP to the troubleshooting table 3 33 Updated the Rate specification 5 1 to 5 7 Added the chapter Infant NCPAP February 2007 D 4 7 Updated the figure and added a description of the balloon size and type selection 4 25 Added a note regarding the date and time Added Addendums Filter Water Trap Processing Instructions Sterilization L2860 101 L3004A L3082A L2889A L3031A September 2008 E Release of Volumetric Capnography L2786 Operator s manual Warranty THE AVEA ventilator systems are warranted to be free from defects in material and workmanship and to meet the published specifications for Two 2 years or 16 000 hours whichever occurs first The liability of Cardinal Health referred to as the Company under this warranty is limited to replacing repairing or issuing credit at the discretion of the Company for parts that become defective or fail to meet published specifications during the warranty period the Company will not be liable under this warranty unless A the Company is promptly notified in writing by Buyer upon discovery of defects or failure to meet published specifications B the defective unit or part is returned to the Company transportation charges prepaid by Buyer C the defective unit or part is received by the Company for adjustment no lat
117. easpiuiasvanicwoihchivandeutdssavaspidideianiteotasrinie disband A eA EAA aaa Taaa 7 1 MACS SAGES ascii ieramen a a i a E iiaa 7 3 VNETA gi E EREE T AEA E A N E A 7 4 Alarm ControlSet aada atida anad iada aai da ait iada iiai 7 5 Alarm TYDES ss cusisetuvcissesiscsnatbnsitvsssiseowsacasssesevinsontossciseiaissouvselesnsintscduelbtusizesisevsstussbeishicoundessiussietcesths 7 6 Chapter 8 Maintenance and Cleaning ss sssesssrsssesrsrnnnnsnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnan 8 1 Cleaning and Sterilization sicisiessessveassvesssscsservvecsvesissessenisssdunsvissausbecssavinsetevsessivesiaasiaissussviisouss ei 8 1 Recommended Periodic Maintenance ss ssssssssssrssrnsnrnnnenunennnnnnnunnnunnnnnnnnnnnnnnnnunnnnnnnnnnnnnnnnnnnnnnnnnenna 8 4 Battery CANO miosna na ss dices a a A hl dasa a aaa bp ddsion dodo aves 8 5 USCS E TE E A A E A E dtvesstesvatvbedosvarseetett tea TATE E 8 8 Appendix A Contact amp Ordering Information ccssssceesseeseseseeeeeseeees A 1 How 10 Call for Servite rsisi na raida a e iiaii aaia A 1 Ordering Partsi a cana tanivtai asaisinaiodetaioein A nies A 2 Appendix Bi Specificati nS iisi B 1 Pn e matic SUPPLY cs ssesseicesesssssssvccsscesvevtacssutcnicsecsetsarstitesodscesstnecusdsurkituesoutslidese diaaa raa aiaia idana aeiia B 1 Electrical SUP ply Sn a a A A AA AA AET B 1 Data Inp t Outputs sciacssseccecissscceccarissacessbatervescesecieasavecesssisteabusetelissacabsintertaateuoesssisdeacnaassisieninterviateneses
118. econds i e If the circuit pressure fails to return to PEEP 5 cmH20 within 5 seconds The safety and exhalation L2786 AVEA ventilator systems Chapter 7 Alarms and Indicators 7 13 Message Alarm Condition _ valves open and no breaths are delivered The SAFETY VALVE OPEN alarm activates Bias flow is suspended while this alarm is active PEEP may not be maintained This alarm will remain lt active until the condition is resolved Range 0 to 60 cmHz0 LOW PEEP Baseline pressure Positive End Expiratory Pressure is less than High the set LOW PEEP alarm threshold for a period greater than 0 25 Defaults 0 05 seconds This alarm is OFF if set to zero 3 cmH20 Adult Pediatric l 1 cmH20 Neonate LOW Ve Monitored exhaled minute volume Ve is less than the set LOW OFF 0 1 to 50 L Adult Medium Ve alarm threshold OFF 0 0 1 to 30 L Pediatric i i OFF 0 0 01 to 5 00 L Neonate Default OFF HIGH Ve _ Monitored exhaled minute volume Ve is greater than the set 0 to 75 L Adult _ Medium HIGH Ve alarm threshold 0 0 to 30 0 L Pediatric _ 0 00 to 5 00 L Neonate Defaults 30 0 L Adult Pediatric 5 00 Neonate HIGH Vt lt The absolute monitored exhaled tidal volume is greater than the 0 10 to 3 00 L Adult Visual set HIGH Vt alarm threshold 25 to 1000 ml Pediatric Alert i _ 2 0 to 300 0 ml Neonate Defaults i 3 0
119. ed to reduce the risk of circuit overheating in the event an active humidifier is in use and left on To ensure flow through the entire ventilator circuit the patient wye should be plugged to direct flow down the expiratory limb of the circuit Failure to do this may result in damage to the ventilator circuit if the humidifier is left on Consult the circuit manufacturer to confirm that 2 L min of flow is sufficient to prevent overheating Note Some alarms such as Loss A C Loss of O2 Loss of Air Loss of Gas will be active in Standby L2786 3 32 Chapter 3 Ventilator Operation Operator s manual Available Breath Types amp Modes by Patient Size Adult and Pediatric Ventilation Modes The following breath types amp ventilation modes are available for Adult and Pediatric patients When a mode is selected its description is displayed at the top left of the touch screen Table 3 1 Adult and Pediatric Displayed Modes Displayed Mode Description Volume A C Volume breath with Assist ventilation Default for adult and pediatric patients Pressure A C Pressure breath with Assist ventilation Volume SIMV Volume breath with Synchronized Intermittent Mandatory Ventilation SIMV and an adjustable level of pressure support for spontaneous breaths Pressure SIMV Pressure Breath with Synchronized Intermittent Mandatory Ventilation SIMV and an adjustable level of pressure support for spontaneou
120. elates to the airway pressure in that they become positive during a positive pressure breath and negative during a spontaneous breath 2 The esophageal tracing may show small cardiac oscillations reflective of cardiac activity 3 Once placed using the above criteria appropriate balloon location can be confirmed by performing an occlusion technique This requires that the airway be occluded and the esophageal and airway pressures compared for similarity After the balloon has been inserted and turned on the ventilator will fill the balloon to the appropriate level and begin monitoring data The ventilator will automatically evacuate and refill the balloon every thirty minutes to ensure accuracy of monitored values WARNING Esophageal balloon placement should only be conducted in patients under the direction of a physician who has assessed the patients for contraindications to the use of esophageal balloons WARNING Incorrect placement of an esophageal balloon can affect the accuracy of monitored values L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 11 MIP P10 Maneuver Screen VOLUME A C MIP 100 KKK joules WOBp 0 0 Spon Ve 0 bpm Spon Rate aK Fi ie Ail 13 b2iimind X AN oa i os fit cmH20 j i ee O a Duration Sensitivity sec emH20 Winin Insp Pause PEEP Flow Trig Figure 4 12 MIP Maneuver Settings The MIP Maxi
121. elow the variable orifice flow sensor connection on the front panel The receptacle is marked with the icon shown here This is a locking connector To attach first pull back the locking collar then push firmly onto the ventilator receptacle To disconnect first retract the plastic collar then firmly pull the connector away from the ventilator Do not pull up or down as this can damage the connector Figure 2 20 Hot wire Flow Sensor Attachment CAUTION Flow sensors must be attached at both the patient wye and at the ventilator connection to ensure proper function of the AVEA Note Hot wire flow sensors will not function with Heliox gas mixtures During Heliox delivery a variable orifice flow sensor should be used for monitoring delivered volumes at the proximal airway Hot Wire Flow Sensor Zero Procedure aorF WN gt It is recommended that this procedure is done when installing a new hot wire flow sensor and as a possible remedy to a drifting waveform baseline The standard hot wire flow sensor is suitable for neonatal and pediatric applications where the peak inspiratory flow rate is less than 30 L min This flow sensor is not active in adult applications The following procedure describes how to reset or re zero the Hot Wire Sensor offset To reset or re zero the Hot Wire Sensor offset Select Utility from the screens menu Select the Monitoring tab from the Utili
122. en VOLUME A c AUTOPEEP Paw cmH20 10 l cmH20 Pmean f i E bpri Rate 2 4 emh2o 21 TO ie a Po Imin Peak Flow l PEEP Flow Tri Figure 4 14 AutoPEEP Maneuver Settings AutoPEEP is the airway pressure at the end of exhalation immediately prior to the beginning of the next mandatory inspiration During the execution of this maneuver the ventilator will execute an expiratory hold in which both the inspiratory and expiratory valves will be closed The ventilator will establish the AutoPEEP measurement when the system pressure reaches equilibration at the next mandatory breath interval or 5 seconds whichever is shorter L2786 4 18 Chapter 4 Monitors Displays and Maneuvers Operator s manual Controls Sensitivity The preset Sensitivity establishes the level that the airway pressure must drop below PEEP to abort the AutoPEEP maneuver Range 0 1 to 5 0 cmH20 Resolution 0 1 cmH20 Default 3 0 cmH20 Start Stop The maneuver begins when the START key is actuated and the ventilator is in exhalation The maneuver will stop immediately when the STOP key is activated the maneuver is completed or a patient effort is detected and normal ventilation will resume Note The maneuver will be aborted if a patient effort is detected and the message bar will indicate a message stating that
123. en real time data refreshing resumes by pressing the Freeze button again the selected loop will remain in the background behind the real time graphic To create a reference loop refer to Figure 4 6 Figure 4 7 and Figure 4 8 and do the following Figure 4 5 Frozen Flow Volume Loop Ref Loop Off Figure 4 6 Reference Loop ON OFF button OFF Saving a loop Press the Freeze button to freeze the loop you wish to use as a reference then press the Save Loop touch screen display in the right hand bar beneath the frozen graphic display Figure 4 6 SRE This puts the selected loop into memory and places a time reference into a field in the left hand bar beneath the graphics i display as shown in Figure 4 7 A total of four 4 loops can be saved at one time When the fifth loop is saved the oldest loop is removed Figure 4 7 Saved Loops Display Creating a reference loop Press the touch screen directly over the touch screen field in the left bar which represents the saved loop you wish to use as a reference The field will highlight Figure 4 7 Press the Ref Loop ON OFF field on the right hand bar Figure 4 6 and Loop on Figure 4 8 to turn the reference loop on Figure 4 8 Reference Loop ON OFF button ON When you press the Freeze button again the reference loop remains visible in the background while the active display places current loops in real time over the top
124. en supply only i LOSS GAS _ All sources of gas fail wall air internal compressor if installed N A _ High SUPPLY and oxygen The safety valve opens indicated by a SAFETY VALVE OPEN message and the patient is allowed to breathe room air PEEP is not maintained NOT The internal blended gas pressure is below 1 psi for greater than Pressure lt 1psi for gt 12 seconds High VENTILATING about 12 seconds indicating there is no ventilation occurring f The safety valve should be open in this condition as there is no pressure to keep the safety valve closed This alarm is only a _ monitor of this pressure level and does not change the state of the ventilator The condition is recoverable if pressure is restored LOW Ppreak The peak inspiratory pressure for a breath is less than the set 3 to 99 cmH20 High LOW Preax Not active for spontaneous breaths Default 3 cmH20 HIGH Ppeak _ Peak inspiratory pressure is greater than the set HIGH Preax _ Normal Breath Range High Inspiration is terminated and the circuit pressure is allowed to Adult i return to baseline pressure 5 1 5 cmH20 before the next 10 to 105 cmH20 _ breath is delivered Default 40 cmH20 Pediatric 10 to 85 cmH20 Default 40 cmH20 Neonate Default 30 cmH20 _ Sigh Breath Range 1 5 x set normal HIGH Ppeak i Only active for sigh breaths EXT HIGH Ppeak Activates whenever the HIGH Ppeax alarm has been active for N A High more than 5 s
125. enseesseenseessensnes 2 3 Front Panel CORNGCUHONS issiimti iieii atai ii 2 11 Setting Up the Rear of the Ventilator sssssssssssssssssssssscsssssssssscssssssssssesssesesessssessssacsssesessssnsensaees 2 18 User Verification LOSE ssutssseiasesvatsusiesseinicsssctupaueis vataswisiesSsvdsbucs ad bossoutasipasbafisiadiaitssuvdseapsntspaceapleaboviehs 2 33 AVEA User Verification Test CheCKliSt ssssssssssssssestssesrsecsssnssssesssssessecsnsessssnssssesssessseasenssessseesses 2 39 AVEA TrOUDICSNOOUNG m snin n a n a Aa a a 2 40 Chapter 3 Ventilator Operation ssssssssssssssenssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnan 3 1 Membrane Buttons an LEDS a sasscassiutscespstsvbsssasiosusestivesaisesinseinscsivacvitunseaniecasnciandupspasesbusstatubvssnasaitess 3 1 LESTA o cai dese A A A T E ANA 3 9 Ventilation Set p siisrs nasan inea aaa aiian aa ta ar ita raaa a aia aE a 3 11 Setting the Ventilation Breath Type and Mode ssessssrussrrsssrenurensnresuunnsnunnnrnnnurensnenunnnunnnnnnnnnnnnnna 3 15 Primary Breath Controls isise a 3 33 Advanced Settings sieissecassssisicsseinseieassutetunncasnuisasivevateunastaisisih wwiesiSods avis asians a a i taiii iaiia 3 39 Independent Lung Ventilation ILV sssssssssssssssssssscssssscsssssssssssessssscessessssesessssacecensesesessasensnsesess 3 47 Chapter 4 Monitors Displays and Maneuvers ssssssssssssssnsnesrnnsrnnnnnnnnnnnnsnnnnnas 4 1 Graphie DISplayS sinerien aaa raaa a eaaa eiaa viduevasivt
126. ensor not connected Ensure sensor properly connected at both the patient wye and at the ventilator Loose external connection Check external connection Internal fault Call Technical Service Vti gt Vte when operating without Normal Condition when operating No action required proximal flow sensors on test lung Normal if readings are within No action required if within ventilator accuracy specifications specification of 10 Defective expiratory flow sensor Clean replace expiratory flow sensor Leak in patient circuit water Verify with leak test collector or exhalation system Vte gt Vti Normal if readings are within No action required if within ventilator accuracy specifications specification of 10 Defective expiratory flow sensor Clean replace expiratory flow sensor Leak in patient circuit water Verify with leak test collector or exhalation system Internal fault Call Technical Service L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 41 Symptom Problem Solution s Volume waveform above or below Humidifier Active on off set Set for Active on for humidifier baseline on patient with internal incorrectly Active off for HME Sensor Normal if readings are within No action required if within ventilator accuracy specifications specification of 10 Bad expiratory flow sensor Clean or replace expiratory flow sensor Internal fault Call Technical Service Volumes become inaccurate over Forei
127. ent AV during inspiration and normalized to the total inspiratory tidal volume Vi WOBp Patient Work of Breathing WOBp normalized to 0 00 to 20 00 10 the total inspiratory tidal volume Patient work of Joules L breathing is defined as the summation of two work components work of the lung and work of the chest wall Requires an esophageal balloon WOB The work performed by the patient to breathe 0 00 to 20 00 10 spontaneously through the breathing apparatus i e Joules L the E T tube the breathing circuit and the demand flow system Requires a tracheal catheter Note Monitored values are displayed as BTPS D 6 Appendix D Monitor Ranges and Accuracies Operator s manual This page intentionally left blank L2786 AVEA ventilator systems E 1 Appendix E Sensor Specifications amp Circuit Resistance VarFlex Sensor Specifications L2786 Table E 1 Varflex Flow Sensor Specifications 41 to 104 F Sensor Infant 15 mm Adult 15 mm Part Number 7002500 7002300 Type Single Use Single Use Circuit Location Wye Wye Performance Specifications Flow Range 0 024 to 30 L min 1 2 to 180 L min Diff Pres Range 5 72 cmH20 5 72 cmH20 Accuracy 0 012 L min 5 or reading 0 1 L min 5 or reading Resistance 4 5 cmH20 30 L min 2 4 cmH20 60 L min Dead Space 0 7 ml installed 9 6 ml installed Freq Response 17 Hz 26 Hz Airway Pres R
128. ented similarly to an E Ratio but it is actually a Time High Time Low Ratio The ratio is displayed in the same format as an I E Ratio with the same rules for transitioning from ratios less than one to ratios greater than one 1 1 1 to 1 1 1 This display is also updated dynamically while the data dial is being rotated when changing any of the patient settings that affect this display This display also reverts to the previously established ratio if the setting change is cancelled or times out APRV BIPHASIC S 34 4 Paw cmH20 mL Vti mL Vte 28 gt Flow L min Vt mL CAN Time High Pres Hit High Time Tow Praka Low 4 0 sec 40sec 20sec 20sec 2 0 Min Max Min Max Figure 4 21 Calculated T High T Low Note Time High and Time Low are maximum time settings for a time cycled transition Actual times may vary depending on the patient s spontaneous breathing pattern and the Sync window setting L2786 4 28 Chapter 4 Monitors Displays and Maneuvers Operator s manual Main Screen Monitors Five monitored parameters are continuously displayed to the left of the graphic displays These are selected in the same way as the displays on the Monitors screen Use the touch screen to select and highlight the monitor you wish to set 2 Turn the data dial beneath the touch screen to scroll through the menu choices To accept your selection either touch the highlighted display or press the accept button adja
129. entification Patient ID You may input a 24 character two x 12 character alphanumeric patient identification To create a patient ID press the Touch Screen directly over the Patient IDENTIFICATION field A secondary screen appears showing the characters available for patient identification Turn the data dial at the bottom of the UIM Figure 3 7 to scroll through the characters Press the ACCEPT membrane key to accept each character and build your Patient ID code When the Patient ID code is complete once again press the Touch Screen directly over the Patient IDENTIFICATION field to accept the entire Patient ID code Check the rest of the screen parameters and if you are satisfied with the setup press the SETUP ACCEPT button ACCEPT CANCEL A N Figure 3 7 Data Dial Accept amp Cancel Button Note Primary breath controls active for the selected highlighted mode are visible at the bottom of the touch screen during setup The Advanced Settings dialog box and the Alarm Limits dialog box can also be opened during setup All controls are active and may be modified while in the Set Up screen 3 14 Chapter 3 Ventilator Operation Operator s manual Note The setup button is disabled during the Pflex MIP P100 and AutoPEEP maneuvers It is active during an Esophageal maneuver EST Extended Systems Test m o oa AAC On Leak Comp Off 8 mm cm Diameter Length PATENT MN IDENTIFICATI
130. entilation is shown as Volume A C APNEA Backup ventilation choices appear when CPAP PSV or APRV BIPHASIC mode is selected Apnea Backup is active in all Assist Control SIMV APRV BIPHASIC and CPAP PSV modes Note When CPAP PSV or APRV BIPHASIC Airway Pressure Release Ventilation is selected you MUST 1 Set the primary and advanced settings for CPAP PSV or APRV BIPHASIC 2 Select the breath type for APNEA backup mode by pressing the Apnea Settings key 3 Set the primary and advanced controls visible at the bottom of the touch screen for the selected apnea breath type before pressing the MODE ACCEPT button The controls for the apnea breath type will not be visible once the MODE ACCEPT button has been pressed Only those controls that are active and required for CPAP PSV or APRV BIPHASIC will remain To review the Apnea backup settings press the Mode button at any time and select APNEA Settings L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 17 Breath Types L2786 This section contains a brief description of the breath types and ventilation mode combinations available for adult pediatric and neonatal patients There are two basic breath types Mandatory breaths delivered according to set ventilator parameters and Demand breaths triggered by the patient All breaths are defined by four variables Trigger initiates the breath Control controls the delivery Cycle primary breath te
131. ents The AVEA compensates for oxygen and helium gas automatically Do not use CO2 measurements as the sole basis for changing ventilation parameters without reference to clinical condition and independent monitors such as blood gas CO2 measurements may be inaccurate in the presence of a breathing circuit leak secretions or sensor malfunction Do not position the COz sensor or cable in any manner that may cause entanglement strangulation or accidental self extubation Use clips as appropriate to secure the sensor cable to the breathing circuit Do not use EtCO as basis for changing ventilation parameters without reference to clinical condition and independent monitors such as blood gas Cautions The CAPNOSTAT 5 contains no user serviceable parts Do not use damaged sensors or cables Do not sterilize or immerse sensors except as directed in this manual Do not apply excessive tension to any sensor cable It is recommended that the CO2 sensor be removed from the circuit whenever an aerosolized medication is delivered This is due to the increased viscosity of the medications which may contaminate the sensor windows causing the sensor to fail prematurely or to display incorrect data Theory of Operation L2786 The CAPNOSTAT 5 measures CO by using the infrared absorption technique which has endured and evolved in the clinical setting for over the past two decades and remains the most popular and versatile technique The princi
132. equal to 4mm ID Dead space lt 1 mL Weight 14 9 g Color Red All components are Latex free L2786 AVEA ventilator systems F 1 Appendix F AVEA Message Bar Text AVEA MESSAGE BAR TEXT CAUSE Confirm Apnea Settings Selection of CPAP PSV or APRV on Mode Select popup when active Proximal Flow Sensor required Acceptance of Volume Limit setting when Size is NEO Volume Limit is active and no Wye Flow Sensor connected Varflex or Hotwire Bias Flow insufficient to allow Flow Trigger Acceptance of Bias Flow setting or Flow Trigger setting when Flow Trigger lt Bias Flow 0 5 Ipm Heliox concentration will change Acceptance of Ov setting when Heliox is being used Nebulizer not available Acceptance of Peak Flow setting lt 15 Ipm when Nebulizer is active or on pressing of Nebulizer membrane key when Peak Flow setting lt 15 Ipm Confirm inspiratory pressure settings Selection of Volume Limit control when Volume Limit active i e not at default highest value for patient size Settings restored to defaults Patient Accept when New Patient selected Compliance Compensation not active for NEO Size Accept when Size is NEO and Circ Comp setting is non zero Minimum 0 2 sec Inspiratory Time Acceptance of any combination of settings that will produce an l Time of less than 0 2 seconds Maximum 4 1 E Ratio
133. er than four weeks following the last day of the warranty period and D the Company s examination of such unit or part shall disclose to its satisfaction that such defects or failures have not been caused by misuse neglect improper installation unauthorized repair alteration or accident Any authorization of the Company for repair or alteration by the Buyer must be in writing to prevent voiding the warranty In no event shall the Company be liable to the Buyer for loss of profits loss of use consequential damage or damages of any kind based upon a claim for breach of warranty other than the purchase price of any defective product covered hereunder The Company warranties as herein and above set forth shall not be enlarged diminished or affected by and no obligation or liability shall arise or grow out of the rendering of technical advice or service by the Company or its agents in connection with the Buyer s order of the products furnished hereunder Limitation of Liabilities This warranty does not cover normal maintenance such as cleaning adjustment or lubrication and updating of equipment parts This warranty shall be void and shall not apply if the equipment is used with accessories or parts not manufactured by the Company or authorized for use in writing by the Company or if the equipment is not maintained in accordance with the prescribed schedule of maintenance The warranty stated above shall extend for a period of TWO 2 years fr
134. essure that is achieved by the patient during an expiratory hold maneuver Range 60 to 120 cmH20 Resolution 1 cmH20 Accuracy 2cmH20 or 5 whichever is greater Respiratory Drive P400 Respiratory Drive P100 is the negative pressure that occurs 100 ms after an inspiratory effort has been detected P100 Pend 100 PEEPaw Range 60 to 120 cmH20 Resolution 1 cmH20 Accuracy 2cmH20 or 5 whichever is greater L2786 AVEA ventilator systems Appendix G Advanced Pulmonary Mechanics Monitored Parameters G 7 Ventilator Work of Breathing WOBy Ventilator Work of Breathing WOBv is defined as the summation of airway pressure Paw minus the baseline airway pressure PEEPaw times the change in tidal volume to the patient AV during inspiration and normalized to the total inspiratory tidal volume Vs If Paw gt PEEPaw gt Paw PEEPaw AV WOBy Insp Vi Range 0 00 to 20 00 Joules L Resolution 0 01 Joules L Accuracy 10 Patient Work of Breathing WOBp Normalized to Delivered Tidal Volume Patient Work of Breathing WOBp normalized to the total inspiratory tidal volume Patient work of breathing is defined as the summation of two work components work of the lung and work of the chest wall WOBp WOBLung WOBcw Tiend where WOBiune gt PEEPss Pes AV if PEEPes gt Pes and V gt 0 Testart and wopcw Ccw if PEEP s gt Pes Work of the lung W
135. est are performed simultaneously with the oxygen sensor calibration The maximum time for the EST is 90 seconds To restart the EST at any time select the Cancel button to return to the set up screen After each test is complete the ventilator will display a Passed or Failed message next to the corresponding test Once the test is complete press the continue button to return to the set up screen 0 0 mLicmH20 Circ Comp HUMIDIFIER Active On EST Setup Accept REMOVE THE PATIENT BLOCK PATIENT CIRCUIT WYE CONT CANCEL Figure 2 46a Remove Patient Instruction EXTENDED SYSTEM TEST Leak Test PASSED Circuit Compliance Test PASSED O2 Sensor Calibration IN PROGRESS 45 sec f owen Figure 2 46b In progress EST EXTENDED SYSTEM TEST Leak Test PASSED Circuit Compliance Test PASSED O2 Sensor Calibration PASSED CONTINUE Figure 2 46c Completed EST Figure 2 45 EST Screens L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 35 The SET UP ACCEPT key must be pressed in order for the AVEA to retain the circuit compliance measurement At this point even after power cycling off if SAME PT is selected the circuit compliance measurement will continue to be retained If NEW PT is selected the EST will be required to use this feature Note If you do not connect the ventilator to an oxygen supply the O2 Sensor Calibration will immediately fail
136. euver WARNING Normal ventilation is suspended for the duration of the maneuver The patient should be evaluated for contraindications prior to executing the maneuver The patient should be directly monitored by trained medical personnel during the maneuver To execute a MIP P100 maneuver set the Duration and Sensitivity controls to the desired level Press the Start soft key on the maneuver screen The ventilator will close the inspiratory and expiratory valves and begin monitoring At the completion of the maneuver the ventilator will display the MIP and P100 values in their respective windows on the maneuver screen The MIP and P100 will also be available as trended data on the Trends screen The maneuver can be aborted at anytime by pressing the Stop soft key Inflection Point Prex Maneuver Screen 1000 cmH20 o F im iF 7 Flow Trig Figure 4 13 Pflex Maneuver Settings The Inflection point Prex maneuver is performed on patients during mandatory ventilation The upper and lower inflection points are automatically indicated on the inspiratory portion of a Pressure Volume Paw Vol Loop L2786 4 14 Chapter 4 Monitors Displays and Maneuvers Operator s manual Note Normal ventilation shall be suspended for the duration of the maneuver The maneuver will be aborted if a patient effort is detected and th
137. ey choose to do so override the Prex values by moving the Prex indicators to a new point along the PV loop and pressing the appropriate set key The corresponding Prex values and delta Prex volume change to represent values based on the current position of the indicators The ventilator will store up to four PV loops and their respective inflection points simultaneously Note Once the values have been redefined by the operator the original values cannot be restored Alarms All currently available alarms shall be active during a Prex maneuver except Apnea Interval and I Time Limit To Perform a Pflex Maneuver L2786 The Pflex maneuver allows the clinician to determine opening pressures of the lung during a slow flow volume controlled breath Because this maneuver is performed at a slow inspiratory flow rate the effects of respiratory system resistance are minimized Note Performance of the Pflex maneuver requires a passive patient In the event that a patient effort is detected the ventilator will abort the maneuver and deliver a patient effort detected message while simultaneously returning to normal ventilation at the current settings From the Maneuvers Screen select Pflex The Pflex maneuver screen allows the operator to set 4 16 Chapter 4 Monitors Displays and Maneuvers Operator s manual Tidal Volume Vt This is the tidal volume delivered to the patient during the maneuver This setting has no effect
138. gen concentration delivered to the patient for 2 minutes If the T 0 key is pressed again within this two minute period the maneuver is cancelled and the ventilator will return to prior settings Defaults 20 Neonatal 79 Adult Pediatric Adult Pediatric 79 above the set O2 Neonate 20 above the set O2 or 100 whichever is less 3 4 Chapter 3 Ventilator Operation Operator s manual To configure the Increase F102 Access the Configuration tab on the Utilities Screen Increase F102 Configures the step increase used during the increase oxygen maneuver Sets the amount of oxygen the ventilator will increase above the current set F102 Example If the Increase Fiz is set at 20 AND The set F102 is 40 WHEN The increase Fl02 Maneuver is activated the F102 will increase to 60 for two minutes after which it will return to 40 The default setting for infants is 20 and 79 for Pediatric and Adult applications Note The settings will be reset to default values when New Patient is selected in the setup Note To achieve 100 delivered F102 during the Increase O2 maneuver set the Increase F102 setting to its maximum of 79 WARNING Heliox delivery will be interrupted for the time that either the Suction or the Increase O buttons are pressed during administration of Heliox Tidal volume may be affected after the 2 minute timeout period or when the button is pressed until the accumulator has been
139. gn material on flow sensor Clean replace sensor time Internal fault Call Technical Service Nebulizer output absent Ventilator running on compressor Connect wall air Flow less than 15 L min Increase flow if appropriate Internal fault Call Technical Service FiO monitor inaccurate or reads O2 sensor requires calibration Perform EST O sensor at end of life Replace O Sensor PEEP too high Exhalation filter cartridge clogged Replace cartridge or saturated Defective exhalation diaphragm Change exhalation diaphragm Unit will not run on A C power Blown fuse on power entry module Replace fuse Power cord not connected to Check connections mains power Unit will not run properly on battery Battery not sufficiently charged Internal battery requires at least 4 hours to be fully charge External battery requires at least 12 hours with green LED lit for a full charge Improper charge level indicator Excessively discharged battery Requires at least 4 hours for full Internal battery charge e The internal battery does not Maintenance and testing required Perform Internal Battery Charge operate for the specified time Monitor Reset e The battery charge level indicator LED is green but the battery operation time is less than specified e The batteries do not appear to maintain adequate charge L2786 2 42 Chapter 2 Unpacking amp Setup Operator s manual Symptom Problem Solution s Improper charge level indicato
140. gnized while operating the ventilator the ventilator must be removed from use and referred to qualified personnel for servicing Using an inoperative ventilator may result in patient injury Battery Care L2786 The AVEA has an internal Nickel Metal Hydride battery pack that will provide power backup for short periods in the event that the mains power supply is lost Figure 8 1 Under normal operating conditions and when fully charged the internal battery is capable of powering the ventilator alone for 1 hour or the ventilator and compressor for 30 minutes Figure 8 1 Internal Battery Pack Note The internal battery is intended only for short duration backup in the event of disruptions in line power The internal battery provides 30 minutes of battery power for the ventilator and compressor nominally The recharging cycle for this battery can be 4 hours or more depending on the state of discharge Should you wish to perform intra facility transport of patients you should equip your instruments with the optional external battery The addition of the external battery will extend the time period to 2 hours for ventilator and compressor Cardinal Health recommends that when used in transport situations the expected transport time should not be greater than 50 of the usable battery life This provides a safety margin in the event of schedule delays or premature consumption of the battery power Should the e
141. h and Pres Low controls The maximum duration at each pressure during time cycling is set with the Time High and Time Low controls The operator can also adjust the length of the respective trigger Sync windows with the Time High and Time Low Sync controls which are advanced settings of Time High and Time Low The Sync windows are adjustable from 0 to 50 in 5 increments of set Time High and Time Low The ventilator synchronizes the change from Pressure Low to Pressure High with the detection of inspiratory flow or the first inspiratory effort detected within the T Low Sync window Transition from Pressure High to Pressure Low occurs with the first end of inspiration detected after the T High Sync window opens Note Time High and Time Low are maximum time settings for a time cycled transition Actual times may vary depending on the patient s spontaneous breathing pattern and the Sync window setting Setting the Sync to 0 cycles the transition between pressure levels on time only and will not provide synchronization with patient efforts The Manual Breath button is not active in APRV BiPhasic The monitored PEEP in APRV BIPHASIC is relative to the breath type In the absence of spontaneous breathing the monitored PEEP will be the Pressure Low In the presence of spontaneous breathing the monitored PEEP will reflect the baseline pressure over which spontaneous breathing is occurred Adjustable PSV in APRV BiPhasic APRV B
142. hageal Pressure dPes Requires an mL cmH20 esophageal balloon L2786 AVEA ventilator systems Appendix D Monitor Ranges and Accuracies D 3 L2786 Ciune The ratio of the tidal volume exhaled to the delta transpulmonary pressure The delta transpulmonary pressure is the difference between the airway plateau pressure during an inspiratory pause and esophageal pressure at the time the airway plateau pressure is measured minus the difference between the airway and esophageal baseline pressures Requires an inspiratory hold and esophageal balloon 0 to 300 mL cmH20 10 C20 C The ratio of the dynamic compliance during the last 20 of inspiration C20 to the total dynamic compliance C 0 00 to 5 00 10 Display Description Range Accuracy Rrs The total resistance during the inspiratory phase of a breath Respiratory System Resistance is the ratio of the airway pressure differential peak plateau to the inspiratory flow 12 ms prior to the end of inspiration Requires an inspiratory hold 0 to 100 cmH20 L sec 10 Rpeak The Peak Expiratory Resistance Rreak is defined as the resistance at the time of the Peak Expiratory Flow PEFR 0 0 to 100 0 cmH20 L sec 10 I Rime The airway resistance between the wye of the patient circuit and the tracheal sensor Requires an inspiratory hold and tracheal catheter 0 0 to 100 0 c
143. hageal Pressure dPes is the difference between peak esophageal pressure and baseline esophageal pressure WOBp Patient Work of Breathing WOBp normalized to the total inspiratory tidal volume WOB Imposed Work of Breathing WOB is defined as the work performed by the patient to breathe spontaneously through the breathing apparatus i e the E T tube the breathing circuit and the demand flow system L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 23 Display Value WOBy Ventilator Work of Breathing WOBv is the summation of airway pressure minus the baseline airway pressure times the change in tidal volume to the patient during inspiration and normalized to the total inspiratory tidal volume AutoPEEP AutoPEEP is the airway pressure at the end of an expiratory hold maneuver dAutoPEEP Delta AutoPEEP dAutoPEEP is the difference between airway pressure at the end of an expiratory hold maneuver and the airway pressure at the start of the next scheduled breath after the expiratory hold maneuver Ptp PEEP Transpulmonary pressure AutoPEEP PtpPEEP is the difference between the corresponding airway and the esophageal pressures at the end of the expiratory hold during an AutoPEEP maneuver AutoPEEPes AutoPEEPes is the difference between esophageal pressure measured at the end of exhalation minus the esophageal pressure measured at the start of a patient initiated brea
144. he MIB port must be connected to a device that meets the IEC60601 1 standard Printer The ventilator has a standard 25 pin female Centronics parallel printer port for interfacing to an external printer Remote Nurse Call The ventilator has a modular jack configured to interface with external systems that are either wired for normally open N O close on alarm or normally closed N C open on alarm signals In the active state the remote alarm can sink 1 0 A Video Output The ventilator provides a video output connector which allows for interfacing to an externally located 256 color 800 x 600 SVGA monitor The Video Output is always enabled Language Support The list of selectable languages on the AVEA are English Chinese Czech Dutch French German Greek Hungarian Italian Japanese Polish Portuguese Russian Spanish and Turkish Atmospheric amp Environmental Specifications Temperature and Humidity Storage Temperature 20 to 60 C 4 to 140 F Humidity 0 to 95 RH non condensing Operating Temperature 5 to 40 C 41 to 104 F L2786 AVEA ventilator systems Appendix B Specifications B 9 Humidity 0 to 95 RH non condensing Barometric Pressure Barometric pressure is measured by an internal barometer automatically This data is displayed as a monitor value on the setup screen Range 760 to 545 mmHg Physical Dimensions Overall Size Ventilator 17 W x 16
145. he operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak to less than or equal to 90 cmH 0 L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 37 L2786 Note In adult and pediatric ventilation a minimum of 2 cmH20 of PSV above PEEP is applied even when the control is set to zero Note IF PSV level is insufficient to meet patient demand premature termination of the breath may occur with auto cycling In these cases the PSV level should be increased slightly Figure 3 28 PSV Waveform In Figure 3 28 breath number 1 represents the flow tracing which occurs when the PSV level is insufficient to meet the patient demand Breath two shows resolution after increasing the PSV level slightly Pressure tracing will show a similar appearance Note Monitored airway pressures inspiratory will be higher than set when AAC is active With an inspiratory pressure setting of zero AAC will still provide an elevated airway pressure to compensate for the resistance of the endotracheal tube Positive End Expiratory Pressure PEEP PEEP is the pressure that is maintained in the patient circuit at the end of exhalation Range 0 to 50 cmH20 Defaults 6 cmH20 Adult Pediatric 3 cmH 0 Neonate Note The ventilator will not allow the operator to set a Peak Inspiratory Pressure Insp Pres or PSV PEEP or baseline pressure in APRV BiPhasic greater than 90 cmH
146. he oxygen supply to the ventilator drops below 18 0 psig 1 2 bar and the Oz control is set gt 21 The patient continues be ventilated by the air supply wall air or internal compressor only Loss of Gas Supply This is a high priority audible visual alarm LOSS GAS SUPPLY is displayed and a high priority tone sounds This alarm is triggered if the ventilator loses all sources of gas wall air internal compressor if present and wall oxygen The safety valve opens indicated by a SAFETY VALVE OPEN visual display and the patient is allowed to breathe room air 7 8 Chapter 7 Alarms and Indicators Operator s manual Note PEEP is not maintained during a LOSS GAS SUPPLY alarm condition When the ventilator safety valve is open the ventilator graphics will indicate a safety state by displaying the color purple Loss of Heliox This is a high priority audible visual alarm LOSS HELIOX is displayed and a high priority tone sounds The alarm is triggered if Heliox is being used and the Heliox supply to the ventilator drops below 18 0 psig 1 2 bar The patient continues to be ventilated by the oxygen supply only Pressure Alarms Low Peak Pressure This is a high priority audible visual alarm LOW Ppeax is displayed and a high priority tone sounds whenever the peak inspiratory pressure for a given breath is less than the preset threshold for Low Ppeak Range 3 to 99 cmH20 Defaults 8 cmH 0 Adult Pediatric 5 cmH20 Neo
147. hough failure of any of the above tests will not prevent the ventilator from functioning it should be checked to make sure it is operating correctly before use on a patient The Power on Self Test POST L2786 This test is run automatically and performs the following checks Processor Self Check ROM Check Sum RAM Test The POST will also check the audible alarms and the LEDs at which time the audible alarm sounds and the LEDs on the User Interface Module flash Normal ventilation commences at the culmination of the POST 2 34 Chapter 2 Unpacking amp Setup Operator s manual The Extended Systems Test EST The EST function is accessed from the Setup screen as shown here Press the SETUP membrane button to the lower left of the UIM to open this screen Leak Comp pa off r cm Length a a IDENTIFICATION lt Ooo kg Pt Weight mm Diameter Figure 2 44 Setup Screen Press the EST touch screen button to select it A message will appear instructing you to remove the patient and block the patient wye After confirming that the patient has been disconnected and the circuit wye blocked press the Continue Cont button The ventilator will perform the EST and display a countdown clock During this test the ventilator will perform e Patient circuit leak test e Patient circuit compliance measurement e Two point calibration of the oxygen sensor The patient circuit compliance measurement and leak t
148. iPhasic features adjustable PSV The PSV is delivered above the current phase baseline pressure PSV breaths are available during Time High also by activating T High PSV an advanced setting of Time High If T High PSV is activated during Time High the ventilator will deliver the same PSV level for both Pressure Low and Pressure High Note The ventilator will not allow the operator to set a Peak Inspiratory Pressure Insp Pres or PSV PEEP or baseline pressure in APRV BiPhasic greater than 90 cmH20 The ventilator will deliver an on screen Pop Up Message stating that the Ppeak gt 90 cmH20 The operator must change the Inspiratory Pressure and or PEEP setting to limit the Poeak to less than or equal to 90 cmH20 This 90 cmH20 limit warning is not active when T High PSV is OFF 3 24 Chapter 3 Ventilator Operation Operator s manual Apnea Ventilation in APRV BiPhasic Apnea ventilation is available in APRV BiPhasic If the patient does not initiate a spontaneous effort or the ventilator does not time cycle between pressure levels before the apnea interval has elapsed the ventilator will alarm for apnea and begin apnea ventilation at the apnea ventilation settings A spontaneous effort from the patient or a transition in baseline pressure will reset the apnea alarm and timer and return the ventilator to APRV BiPhasic ventilation Airway Pressure Release Ventilation APRV BIPHASIC Time High Pressure High Pressur
149. iate a non cancelable alarm The ventilator should be immediately connected to an appropriate AC power source AC indicator Green Yellow Red P Figure 7 1 Front Panel Display Area Comprehensive model shown L2786 AVEA ventilator systems Chapter 7 Alarms and Indicators 7 3 Messages L2786 The AVEA displays messages in one of two ways In a Popup message box In the Message bar at the bottom right of the touch screen Alert Messages that require an acknowledgement from the user appear in a pop up message box with an OK or Continue button When you press the acknowledgement button the message disappears and the ventilator continues normal functioning Popup Alert Messages These messages will require you to press a button to clear the Popup box Can t change Mode to APRV BiPhasic when ILV is active e Can t set Pres Low higher than Pres High Can t set Pres High lower than Pres Low Stored Settings and Configuration Data lost Settings restored to defaults Check Barometric Pressure setting Stored Settings lost Settings restored to defaults e Stored Configuration Data lost Check Barometric Pressure setting Can t change size to PED or ADULT when Mode is TCPL Can t change size to NEO when Mode is PRVC Can t change size to NEO when Mode is APRV BiPhas
150. ic Can t change patient size when Machine Volume is active ILV is not available when Mode is APRV BiPhasic Can t disable O2 Alarms when Heliox is in use e Ppeak gt 90cmH20 Barometric pressure calibration invalid Call service representative Using 760mmHg The Message Bar Messages not requiring acknowledgement or response appear in the Message Bar located at the bottom right of the touch screen A complete list of text with explanations for those messages that appear in the message bar is provided in Appendix F 7 4 Chapter 7 Alarms and Indicators Operator s manual Alarms Alarm Categories AVEA ventilator alarms are grouped into three categories High priority warning This category of alarm requires immediate action For a high priority alarm the alarm indicator is RED and the alarm icon flashes at a rate of 2 Hz fast A high priority alarm sounds a series of five tones three low and two high repeated at intervals of 6 seconds Medium priority caution A medium priority alarm displays a yellow indicator and the alarm icon flashes at Hz slow A medium priority alarm sounds three tones all at the same pitch repeated at intervals of 20 seconds Low priority advisory A low priority alarm or advisory displays a yellow indicator and the alarm icon does not flash A low priority alarm sounds a single tone which is not repeated There are visual displays for all categories of alarms A text
151. ice Error On detection of a fault classified as Device Error Esophageal Balloon Leak Test Failed On failure of Esophageal Balloon leak test Stopped Patient Effort Detected Upon detecting Patient effort in maneuvers which require a passive patient Proximal Flow Sensor Ready L2786 AVEA ventilator systems G 1 Appendix G Advanced Pulmonary Mechanics Monitored Parameters Rapid Shallow Breathing Index f V L2786 The ventilator is capable of displaying the calculated value for Rapid Shallow Breathing Index f Vi which is the spontaneous breath rate per tidal volume and is based on the following formula f Vi f2 Ve where f spontaneous breath rate BPM and Ve spontaneous minute ventilation in LPM Range 0 to 500 b4 min L Resolution 1 b2 min L Chest wall Compliance Ccw Chest wall Compliance Ccw is the ratio of the tidal volume exhaled to the Delta Esophageal Pressure dPes Range 0 to 300 mL cmH20 Resolution 1 mL cmH20 Note Requires an esophageal balloon catheter Accuracy 10 Lung Compliance C unc Lung Compliance Cune is the ratio of the tidal volume exhaled to the delta transpulmonary pressure The delta transpulmonary pressure is the difference between the airway plateau pressure during an inspiratory pause and esophageal pressure at the time the airway plateau pressure is measured minus the difference between the ai
152. ief Valve and Outlet Manifold Compressor Flow I Optional Alt Inlet Oxygen Accumulator Flow Control Flow Sensor Se Patient Oxygen Pneumatics Blender System Valve Manifold Flow Figure C1 Gas Delivery Engine L2786 C 2 Appendix C Pneumatic Diagram Operator s manual This page intentionally left blank L2786 AVEA ventilator systems D 1 Appendix D Monitor Ran L2786 DISPLAY es and Accuracies DESCRIPTION RANGE__ ACCURACY VOLUME MONITORS The volume measured during the inspiratory phase of the breath is accumulated as the inspired tidal volume and the volume measured during the exhalation phase is accumulated as the exhaled tidal volume This volume does not include the volume delivered by the Circuit Compliance Compensation function for volume breaths Rate weight Breath Rate 0 to 200 bpm Vte Exhaled tidal volume Exhaled volume readings are 0 to4L 20ml 10 of reading Adult machine measured by the expiratory flow sensor This sensor reading may be affected by the humidifier setting in 1 ml 10 of reading Neonate wye the ventilator When using a proximal flow sensor sensor the VTe is measured as the expiratory flow goes away from the patient at the point of insertion of the sensor between the patient interface and the wye Vtelkg Exhaled tidal volume adjusted for patient weight 0 to 4 ml kg Vti Inspire
153. ig Sets the level below PEEP at which the inspiratory trigger mechanism is activated When the pressure in the patient circuit falls below PEEP by the set pressure trigger level the ventilator will cycle to inspiration Range 0 1 to 20 0 cmH20 Default 3 0 cmH20 Vsync Vsync breaths are e Controlled by pressure inspiratory PEEP and volume e Limited by pressure inspiratory PEEP margin e Cycled by time Inspiratory time in Vsync is determined indirectly by setting the peak inspiratory flow The set inspiratory time is displayed in the message bar L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 45 L2786 Vsync breath operation is as follows When Vsync is selected a decelerating flow volume test breath to the set tidal volume with a 40 msec pause is delivered to the patient The ventilator sets the target pressure at the end inspiratory pressure of the test breath or the first pressure control breath The next breath and all subsequent breaths are delivered as pressure control breaths Inspiratory pressure is adjusted automatically based on the dynamic compliance of the previous breath to maintain the target volume The maximum step change between two consecutive breaths is 3 centimeters of water pressure The maximum tidal volume delivered in a single breath is determined by the Volume Limit setting This test breath sequence is initiated when any of the following occur e Entering the Mode Vsync
154. ime is changed Note Calculated I E ratio is not active in APRV BIPHASIC mode Calculated Minute Volume Calc Ve The ventilator displays the Calculated Minute Volume at the bottom left of the Main screen as follows Calc Ve Set tidal volume x Set breath rate This display is updated while the data dial is being rotated when changing any of the primary patient settings that affect these displays in order to view the Calculated Ve that results when the setting change is accepted before accepting that change This display reverts to the previously established values if the setting change is cancelled or times out Limitation For Volume breaths only The Calc Ve display only changes if the set tidal volume or set breath rate is changed Calculated Time High amp Time Low Min Max The AVEA displays the calculated minimum and maximum Time High and Time Low in APRV BiPhasic ventilation The display is located immediately under the Time High and Time Low primary controls on the main screen L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 27 Calculated Time High Time Low Ratio The AVEA displays the calculated ratio corresponding to the ratio ot Time High divided by Time Low in APRV BiPhasic ventilation The display is located between the displays of Time High and Time Low where the minimums and maximums are displayed and below the display of the Pressure High setting This ratio is pres
155. in which the pressure level during inspiration is a preset PSV level plus PEEP The minimum pressure support level is PEEP 2 cmH 0 in adult and pediatric applications independent of the set PSV pressure level In neonatal applications the minimum pressure support level is Zero PSV breaths are e Controlled by pressure preset PSV level PEEP e Limited by pressure preset PSV level PEEP e Cycled by time PSV Tmax or flow PSV Cycle Pressure Support is active when CPAP PSV SIMV or APRV BiPhasic modes are selected 3 20 Chapter 3 Ventilator Operation Operator s manual Note The ventilator will not allow the operator to set a Peak Inspiratory Pressure Insp Pres or PSV PEEP or baseline pressure in APRV BiPhasic greater than 90 cmH20 The ventilator will deliver an on screen Pop Up Message stating that the Ppeak gt 90 cmH20 The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak to less than or equal to 90 cmH 0 2 Spontaneous breath In adult and pediatric applications a Spontaneous breath is a demand breath where the pressure level during inspiration is preset at PEEP 2 cmH20 In neonatal applications a Spontaneous breath is a demand breath delivered only at the preset PEEP Note IF PSV level is insufficient to meet patient demand premature termination of the breath may occur with auto cycling In these cases the PSV level should be increased slightly
156. ind ld bpm mo Lmin sec cmH20 ae Rate Volume Peak Flow Insp Pause PEEP Flow Trig Fi02 Calc Ve L 070se Figure 4 10 Esophageal Maneuver Settings Controls SELECT ESOPHAGEAL BALLOON SIZE AND TYPE Pediatric Size Esophageal Naso Gastric Balloon Tube Balloon MANEUVER m Adult Size Esophageal Naso Gastric Balloon Tube Balloon Accept Figure 4 11 Select Esophageal Balloon Size and Type L2786 Chapter 4 Monitors Displays and Maneuvers Operator s manual Selecting Balloon Size and Type Upon connection of the Balloon Extension Tubing the ventilator will display the Esophageal Balloon Size and Type dialogue box You must select the size and type of balloon you intend to use before you will be able to conduct the Balloon Test Note Disconnecting the Balloon Extension Tubing will require you to select balloon size and type and repeat the balloon test procedure In order to change balloon size or type you must disconnect and re connect the balloon extension tubing to open the Esophageal Balloon Size and Type dialogue box Selecting a balloon size and type other than the one to be used can result in failure of the balloon test Balloon Leak Size Test The Balloon Test verifies the integrity and size of the balloon catheter The ventilator will display a Pass or Fail message in the message bar at the bottom of the screen If the Balloon Test is not passed all connections should be checked to assu
157. ing loops 4 5 freezing a loop 4 5 reference 4 5 L2786 AVEA ventilator systems Index 3 reference loops 4 5 saving a loops 4 5 selection 4 4 loops in real time 4 4 loops screen 4 4 low priority alarm 7 4 M mach vol 3 42 main screen monitors gt 4 28 mandatory breath 3 17 mandatory tidal volume 4 21 D 1 adjusted for patient weight 4 21 D 1 mean inspiratory pressure 4 22 D 2 medium priority alarm gt 3 8 7 4 membrane button expiratory hold 3 5 membrane buttons accept button 3 4 advanced settings 3 6 alarm limits 3 3 alarm reset 3 2 alarm silence 3 2 cancel 3 4 freeze 3 7 increase O2 3 3 inspiratory hold 3 5 main 3 8 manual breath 3 3 mode 3 6 nebulizer 3 5 panel lock 3 6 print 3 6 screens 3 8 setup 3 6 suction 3 3 membrane buttons and LEDs 3 2 minute volume 4 21 D 1 adjusted for patient weight 4 21 D 1 monitor screen 4 20 monitored values 4 20 monitored values choices 4 21 multiple alarms 7 4 N nebulizer 2 15 3 5 neonatal patient circuit 2 12 new patient key 3 9 L2786 NIST fittings 2 19 0 O2 percentage 3 33 optional external battery 2 3 ordering parts A 1 oxygen inlet pressure 4 22 D 2 oxygen sensor 2 18 cable 2 19 cell 2 19 oxygen supply 2 1 P passive humidifier or HME 2 11 patient effort 3 21 3 22 K 1 patient ID 3 13 patient select
158. ing or 2 cmH20 cmH20 whichever is greater Pplat Plateau pressure If no plateau occurs then the 0 to 120 3 5 of reading or 2 cmH20 monitor displays cmH20 whichever is greater PEEP Positive end expiratory pressure 0 to60cmH20 3 5 of reading or 2 cmH20 whichever is greater Air Inlet Air inlet gas supply pressure 0 to 80 psig 5 psig 1 4 5 5 bar O2 Inlet Oxygen inlet gas supply pressure 0 to 80 psig 5 psig 1 4 5 5 bar Pbaro Barometric pressure 760 to 545 2 of full scale mmHg or 101 to 72 7 KPA e PO e OR Fio2 Delivered percent O2 0 to 100 3 MECHANICS Cdyn Dynamic Compliance Copyn and Coyn Kg 0 to 300 Derived absolute and normalized to patient weight ml cmH20 Cdyn Kg 0 00 to 5 00 ml cmH20 kg Cstat Respiratory System Compliance Crs a k a 0 to 300 Derived Static Compliance Cstar absolute and normalized ml cmH20 CstatiKg t0 patient weight 0 00 to 5 00 Note This requires an Inspiratory Hold maneuver mlicmH20 kg Rrs Respiratory system resistance 0 to 100 Derived Note Calculation is performed during an Inspiratory CMH20 L sec Hold maneuver PIFR Peak Inspiratory flow rate 0 to 300 L min 10 of setting or 0 2 L min 10 All patients of setting whichever is greater PEFR Peak Expiratory flow rate 0 to 300 L min 10 of setting or 0 2 L min 10 All patients of setting whichever is greater Ccw The ratio of the tidal volume exhaled to the Delta 0 to 300 10 Esop
159. ion of auditory alarm signals for certain alarm conditions Alarm Reset The Alarm Reset button deactivates visual indicators for alarms that are no longer active Alarm Types Machine Alarms Safety Valve Open This is a high priority audible visual alarm SAFETY VALVE OPEN is displayed and a high priority tone sounds whenever the Safety Valve is open Ventilator Inoperative This is a high priority audible visual alarm VENT INOP is displayed if the ventilator fails due to a non recoverable condition such as loss of power or supply gases A high priority tone sounds The safety valve opens indicated by a SAFETY VALVE OPEN alarm message and the patient is allowed to breathe room air Note PEEP is not maintained during a VENT INOP or a SAFETY VALVE OPEN alarm condition When the ventilator safety valve is open the ventilator graphics will indicate a safety state by displaying the color purple Not Ventilating This is a high priority audible visual alarm NOT VENTILATING is displayed if the internal blended system pressure drops below 1 psi for greater than about 12 seconds The time delay on this alarm allows a transient drop in pressure due to high patient demand This alarm is triggered when there is a component failure that is preventing ventilation from occurring The Safety Valve is normally held physically closed by this system pressure and therefore the safety valve should be open if there is no system pressure at th
160. ion on the Comprehensive AVEA Note In applications which generate high resistances within the breathing system monitored Proximal Airway Pressure may be higher than set Inspiratory Pressure L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 17 Comprehensive Model Only Esophageal Balloon The connection intended for an esophageal balloon is circled in green at the top of the front panel as shown here It is identified with the legend Pes Figure 2 24 Esophageal balloon connector Note See Chapter 4 Monitors Displays and Maneuvers for placement technique for esophageal balloons Tracheal Catheter A tracheal catheter will attach to the AVEA at the connection on the front panel marked as Aux The connector is shown in Figure 2 23 Note See Chapter 4 Monitors Displays and Maneuvers for placement technique for tracheal catheters WARNING The AVEA is designed to ensure that the user and patient are not exposed to excessive leakage current per applicable standards UL2601 and IEC60601 1 However this cannot be guaranteed when external devices are attached to the ventilator To prevent the risk of excessive enclosure leakage current from external equipment attached to the RS 232 printer or video ports the protective earth paths must be isolated to ensure proper connection This isolation should ensure that the cable shields are isolated a
161. ion tubing to the EPM panel on the AVEA as described in Chapter 2 Remove the new esophageal balloon from its package and connect it to the pinned connector on the patient end of the extension tubing 4 10 Chapter 4 Monitors Displays and Maneuvers Operator s manual Allow the balloon to hang freely and not contact any surfaces and press the Balloon Test soft key on the maneuver screen The ventilator will perform a leak test by evacuating the balloon filling it to the proper specification measuring the balloon pressure and finally evacuating the balloon A message will appear on the message bar after the test stating Pass or Fail In the event that the balloon does not pass the leak test inspect the balloon for damage and replace if necessary If no damage is present on the balloon check all connectors on the balloon and extension tubing and repeat the test Note Disconnecting the balloon after passing a balloon test will require that the test be repeated Once the balloon has passed the leak test it is ready for placement in the patient Proper placement of the balloon is imperative for accurate measurements During insertion the waveform produced can provide information to confirm proper placement An approximate level of placement can be made by measuring the distance from the tip of the nose to the bottom of the earlobe and then from the earlobe to the distal tip of the xiphoid process 1 The esophageal pressure waveform corr
162. is control is only available in APRV BIPHASIC Mode It controls the baseline pressure achieved during Time High Range 0 to 90 cmH20 Default 15 cmH20 Time High Available in APRV BIPHASIC mode only this control sets the maximum time for which the Pressure High setting is maintained Range 0 2 to 30 seconds Default 4 seconds L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 39 Time Low In APRV BIPHASIC mode this control sets the maximum time for which the Pressure Low setting is maintained Range 0 2 to 30 seconds Default 2 second Pressure Low In APRV BIPHASIC Mode this control sets the baseline pressure achieved during Time Low Range 0 to 45 cmH20 Default 6 cmH20 Advanced Settings Accessing the Advanced Settings L2786 When the mode and the primary breath controls have been set you can further refine delivery of the breath by accessing the Advanced Settings To access the advanced settings group press the ADV SETTINGS membrane button located to the left of the touch SEE screen between the Mode and the Set up buttons The LED indicator on the button illuminates and the Advanced Settings fetes screen appears When you select a primary control by pressing and highlighting the control at the bottom of the touch screen aS the available advanced settings for that selected control appear in the advanced settings screen Figure 3 29 Advanced Settings membrane button P
163. is location to keep the Safety Valve closed This alarm is differentiated from Safety Valve Open as the software is not driving the Safety Valve to an open state and the L2786 AVEA ventilator systems Chapter 7 Alarms and Indicators 7 7 software cannot determine the physical state of the Safety Valve This is a local alarm only and is not transmitted via any communication protocol however other alarms should always be active and transmitted the primary purpose of this new alarm message is to provide clarification and differentiation from Circuit Disconnect to alert the operator that there is a potential machine fault The first thing the operator should check for is a compressed gas source If the Not Ventilating message is displayed without an accompanying Loss of Gas alarm the unit should be removed from service Fan Failure This is a low priority audible visual alarm FAN FAILURE is displayed and low priority tone sounds whenever the circulating fan at the rear of the ventilator cabinet stops rotating Circuit Disconnect Alarm This is a high priority audible visual alarm The ventilator will sound a disconnect alarm when total expiratory flow inclusive of bias flow is less than 10 of total inspiratory flow inclusive of bias flow for 5 seconds Additionally in neonatal applications when a proximal flow sensor is used the circuit disconnect is sounded when the Percent Leak Vti Vte Vti is greater
164. itored Parameters G 3 Imposed Resistance Rime Imposed Resistance Rimp is the airway resistance between the wye of the patient circuit and the tracheal sensor Range 0 0 to 100 0 cmH20 L sec Resolution 0 1 cmH2O L sec Note Requires an Inspiratory Hold maneuver and a tracheal catheter Accuracy 10 Lung Resistance Riunc Lung Resistance Riunc is the ratio of the tracheal pressure differential peak plateau to the inspiratory flow 12 ms prior to the end of inspiration Range 0 0 to 100 0 cmH20 L sec Resolution 0 1 cmHzO L sec Note Requires an Inspiratory Hold maneuver and a tracheal catheter Accuracy 10 Peak Inspiratory Flow Rate PIFR The ventilator is capable of monitoring and displaying the actual peak inspiratory flow rate for the inspiratory phase of a breath Range 0 to 300 LPM All patients Resolution 1LPM Adult Pediatric 0 1 LPM Neonate Accuracy 10 Peak Expiratory Flow Rate PEFR The ventilator is capable of monitoring and displaying the actual peak expiratory flow rate for the expiratory phase of a breath Range 0 to 300 LPM All patients Resolution 1LPM Adult Pediatric 0 1 LPM Neonate Accuracy 10 L2786 Appendix G Advanced Pulmonary Mechanics Monitored Parameters Operator s manual Delta Airway Pressure dPaw Delta Airway Pressure dPaw which is the difference between peak airway pressure Ppeak aw and baseline airway pressure PEEPaw d
165. izes Extra small Small Large Sherwood Medical St Louis MO General Specifications nCPAP Level Range 2 to 10 cmH20 Resolution 1 cmH20 Default 2 cmH20 Accuracy 2cmH20 nCPAP Flow Flow delivery is under software control and limited to a maximum of 15LPM Advanced Settings There are no advanced settings for the primary settings in Nasal CPAP L2786 6 2 Chapter 6 Infant NCPAP Operator s manual Alarms The Alarms Settings Screen does not open in Nasal CPAP Existing machine alarms and safety systems will be maintained During nCPAP support certain alarms will be suspended Alarms suspended during nCPAP Time Based Alarms Volume Based Alarms Pressure Alarms High Rate High Ve High Ppeak I Time Limit High Vt Ext High Peak Alarm 1 E Limit Low Vte Low PEEP Apnea Interval Low Ve Low Ppeak Volume Limit Occlusion Alarms added during nCPAP High nCPAP Pressure A high priority audible visual alarm is activated whenever the nCPAP Pressure exceeds the threshold for a period greater than 15 seconds Alarm threshold is automatically updated on acceptance of control setting Threshold Set nCPAP level 3 cmH20 or Pressure Limit Low nCPAP Pressure A high priority audible visual alarm is activated whenever the nCPAP Pressure falls below the threshold for a period greater than 15 seconds Alarm threshold is automatically updated on acceptance of control setting Threshold Set nCPAP level 2 cmH20 If n
166. l Alarms Test 3 Select the appropriate patient size for your test Adult Pediatric or Neonate from the Patient Size Select Screen Accept this selection by pressing SIZE ACCEPT Set Humidifier Active off 4 Make any desired changes or entries to the Ventilation Setup Screen and accept these by pressing SETUP ACCEPT 5 Press Alarm Limits button on the upper right of the user interface L2786 Chapter 2 Unpacking amp Setup Operator s manual Verify that no alarms are active and clear the alarm indicator by pressing the alarm reset button on the upper right of the user interface Set the Oz control to 100 Disconnect the Oxygen sensor from the back panel of the ventilator and verify that the Low Ozalarm activates Return the O2 control setting to 21 with the sensor still disconnected from the rear panel Remove sensor from back panel Provide blow by to the sensor from an external oxygen flow meter Verify that the High O alarm activates Return the O2 to 21 reconnect the Oxygen sensor to the back panel Clear all alarm messages by pressing the alarm reset button Set PEEP to 0 Set Low PEEP alarm to 0 Disconnect the patient wye from the test lung Verify that the Low Ppeak alarm activates followed by the Circuit Disconnect alarm This second alarm should activate within 15 seconds or one breath cycle Reconnect the test lung to the circuit clear the alarm by pressing the reset button Disconnect the AC power cord from the
167. ll situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people L2786 AVEA ventilator systems K 1 Appendix K Glossary L2786 Breath Interval Elapsed time from the start of one breath to the start of the next Preset An operator set ventilator parameter Value at which the ventilator initiates delivery of a breath Trigger as a result of measured patient effort BTPS Body Temperature at Ambient Pressure Saturated ATPD Ambient Temperature Ambient Pressure Dry Demand Flow The flow generated by the ventilator to meet the patient s flow demand in order to maintain PEEP at the preset level AC Alternating Current mains electricity Flow through the patient breathing circuit during the Bias Flow expiratory phase This flow is used for flow triggering bpm Breaths per minute Breath Period The length of time between machine initiated breaths Depends on the Breath Rate setting Breath Rate The number of breaths delivered in a minute BTPD Body Temperature at Ambient Pressure Dry Button A push button switch used to toggle a function on or off cmH O Centimeters of water pressure c Any button switch or knob that allows you to modify the ontrols ventilator s behavior The occurrence or activation of certain controls or Event functions of the ventilator or
168. low sensor Whenever a proximal flow sensor is used Neonatal Pediatric or Adult applications the Volume Limit is activated by the inspiratory tidal volume measured by the wye flow sensor In adult and pediatric applications where no wye flow sensor is used Volume Limit is determined by the calculated inspiratory wye flow When the volume limit threshold has been reached the ventilator alarm status indicator will change to yellow and display the words Volume Limit The alarm status indicator cannot be reset until the ventilator has delivered a breath which does not meet the volume limit threshold To reset the alarm status window use the alarm reset button CAUTION If a proximal flow sensor is used it must be attached at both the patient wye and at the ventilator connection to ensure proper function of the AVEA Note Excessive inspiratory flow rates or highly compliant ventilator circuits may allow delivery of a tidal volume that exceeds the volume limit setting This is due to the ventilator circuit recoiling and providing additional tidal volume to the patient Delivered tidal volumes should be closely monitored to ensure Volume Limit accuracy 3 42 Chapter 3 Ventilator Operation Operator s manual Machine Volume Mach Vol The Machine Volume control sets the minimum tidal volume delivered from the ventilator when the control is activated in a pressure control breath This control is always used with the time cycling
169. m signals Cables for both systems are available from Cardinal Health Date Time Tab L2786 UTILITY VOLUME A C Y il gt gt i O ER fy pg Figure 2 42 Utility Screen Date Time Tab Setting the Date Using the touch turn touch technique use the data dial to set the correct month day and year prior to use of the ventilator Setting the Time Using the touch turn touch technique use the data dial to set the correct time in hours and minutes prior to use of the ventilator Note After changing the date and or time cycle the ventilator off then on and select NEW PT to ensure coordination of the EVENTS and TRENDS with the new date time set Chapter 2 Unpacking amp Setup Operator s manual Powering up the AVEA To power up the ventilator connect the power cord to a suitable AC power supply and turn on the power switch located on the back panel of the ventilator as shown here Figure 2 43 Power Switch The power up reboot time for this instrument is approximately 7 seconds WARNING A protective ground connection by way of the grounding conductor in the power cord is essential for safe operation If the protective ground is lost all conductive parts including knobs and controls which may appear to be insulated can render an ele
170. mH20 L sec 10 I Rune The ratio of the tracheal pressure differential peak plateau to the inspiratory flow 12 ms prior to the end of inspiration Requires an inspiratory hold and tracheal catheter 0 0 to 100 0 cmH20 L sec 10 I dPaw The difference between peak airway pressure Ppeak aw and baseline airway pressure PEEPaw 120 to 120 cmH20 2 cm H20 or 5 whichever is greater dPes The difference between peak esophageal pressure Ppeak es and baseline esophageal pressure PEEPes 120 to 120 cmH20 2 cm H20 or 5 whichever is greater AutoPEEP The airway pressure at the end of an expiratory hold maneuver Requires a passive patient 0 to 50 cmH20 2 cm H20 or 5 whichever is greater dAutoPEEP The difference between airway pressure at the end of an expiratory hold maneuver and the airway pressure at the start of the next scheduled breath after the expiratory hold maneuver Requires a passive patient 0 to 50 cmH20 2 cm H20 or 5 whichever is greater AutoPEEPes The difference between esophageal pressure measured at the end of exhalation PEEPes minus the esophageal pressure measured at the start of a patient initiated breath Pes start and the sensitivity of the ventilator s demand system The sensitivity of the ventilator s demand system is the difference between the baseline airway pressure PEEPaw and the airway pressure
171. mbly on site 2 1 assist control ventilation mode 3 21 attaching the flow sensors 2 13 attaching the patient circuit 2 11 B Backup Alarm 7 4 base flow 3 44 battery cord 2 3 battery pack 8 5 external 8 5 battery replacement 8 6 battery status indicator 7 2 battery status indicators 8 7 bias flow 3 38 3 44 K 1 breath interval 3 5 3 21 3 22 3 35 breath interval timing mechanism 3 21 breath rate 3 21 3 22 3 35 4 21 4 26 7 11 7 13 D 1 breath type and delivery mode 3 16 breath types 3 17 3 22 K 1 breath types and modes by patient size adult and pediatric 3 32 breaths defined by four variables 3 17 C calculated IE Ratio 4 26 calculated minute volume 4 26 cautions xi choice of waveforms 4 2 circuit compliance 1 3 3 12 Index 2 Index Operator s manual circuit compliance compensation 1 3 3 12 Circuit Occlusion Alarm 2 36 cleaning and sterilization accessories and parts 8 1 external surfaces 8 1 colors on waveform display 4 1 compliance effect of the circuit 1 3 3 12 compressed gas sources 2 1 connecting the O2 sensor 2 19 contacting the manufacturer A 1 control knob 4 2 4 3 4 20 4 28 7 6 controls associated with each breath type amp mode 3 40 cord routing 2 3 CPAP PSV mode 3 16 3 19 3 25 customer service A 2 D data dial 3 34 default mode for all patient types 3 21 demand breaths 3 19 disable the audible al
172. mpensation Leak Compensation is used to compensate for baseline leaks which may occur at the patient mask interface or around the patient s endotracheal tube It only provides baseline leak compensation and is not active during breath delivery During exhalation PEEP is maintained by the cooperation of the Flow Control Valve FCV and the Exhalation Valve ExV The ExV pressure servo is set to a target pressure of PEEP and the FCV pressure servo is set to a pressure target of PEEP 0 4 cmH20 The ExV servo relieves when the pressure is above its target and the FCV supplies flow when the pressure drops below its target up to a maximum flow rate for the patient size Range Off On Default Off Circuit Compliance Compensation L2786 When Circuit Compliance is active the volume of gas delivered during a volume controlled or targeted breath is increased to include the set volume plus the volume lost due to the compliance effect of the circuit Circuit Compliance is active for the set Tidal Volume during volume control ventilation the Target Tidal Volume in PRVC mode and for Machine Volume It is only active in Adult and Pediatric applications Exhaled volume monitors for all modes and breath types are also adjusted for the compliance compensation volume Range 0 0 to 7 5 ml cmH20 Default 0 0 ml cmH20 The ventilator automatically measures Circuit Compliance during the Extended Systems Test EST The value cannot be entered manually
173. mum Inspiratory Pressure Poo maneuver measures the negative deflection in the pressure tracing during the patient s active effort to demand a breath During the maneuver the inspiratory flow valve remains closed and no inspiratory flow is delivered The MIP is an indication of the maximum negative pressure that the patient can draw while P40 is an indication of the pressure drop that occurs during the first 100 milliseconds of the breath Controls Duration The preset Duration shall determine the maximum amount of time that the maneuver will last Normal ventilation will be suspended for the duration of the maneuver and will resume after the duration has timed out Range 5 0 to 30 0 seconds Default 10 seconds L2786 4 12 Chapter 4 Monitors Displays and Maneuvers Operator s manual Sensitivity The maneuver sensitivity establishes the level below PEEP that the airway pressure must drop which determines the onset of a patient effort This allows the clinician to set the maneuver appropriate to patient ability Range 0 1 to 5 0 cmH20 Resolution 0 1 cmH20 Default 3 0 cmH20 Note Excessively high setting of the maneuver sensitivity can affect the accuracy of timing for P100 determination Start Stop The maneuver begins when the START key is actuated The maneuver will be immediately terminated should the operator activate the STOP key and normal ventilation will resume Note If the Start key is activated
174. n delivered to the patient will differ from that set on the O2 control setting e Asource gas failure will change the FiOz and may result in patient injury e The functioning of this equipment may be adversely affected by the operation of other equipment nearby such as high frequency surgical diathermy equipment defibrillators short wave therapy equipment walkie talkies or cellular phones e Water in the air supply can cause malfunction of this equipment e Do not block or restrict the Oxygen bleed port located on the instrument back panel Equipment malfunction may result L2786 AVEA ventilator systems xi Electric shock hazard Do not remove any of the ventilator covers or panels Refer all servicing to an authorized Cardinal Health service technician A protective ground connection by way of the grounding conductor in the power cord is essential for safe operation Upon loss of protective ground all conductive parts including knobs and controls that may appear to be insulated can render an electric shock To avoid electrical shock plug the power cord into a properly wired receptacle use only the power cord supplied with the ventilator and make sure the power cord is in good condition The AVEA is designed to ensure that the user and patient are not exposed to excessive leakage current per applicable standards UL2601 and IEC60601 1 However this cannot be guaranteed when external devices are attached to the ventilat
175. n the preceding illustration L2786 AVEA ventilator systems Chapter 5 Volumetric Capnography 5 5 Settings and Monitored Values Settings The setup and utilities controls are accessed by pressing the Screens button selecting Utility and selecting the Monitoring tab Configuration Input Output Date Time Monitoring Disabled Calibration Check Breath Minute EtCO2 Avg CO2 Avg Figure 5 6 Monitoring Tab in Utility Screen Capnography Enable Disable When CO monitoring is enabled all CO2 monitoring and alarm functions are also enabled When CO2 Monitoring is disabled all CO2 monitoring and alarm functions are disabled Range Enable or Disable Default Disable EtCO Averaging EtCOz is measured for each breath You can select the number of breaths over which the displayed EtCOz is averaged Range 1 or 8 breath s Default 8 breaths Vco2 Averaging VCO gt 2 is updated at one minute intervals You select the time over which the displayed VCO is averaged Also averaged over this time period are Vd Vd Vt VtCO2 and VA Range 3 6 9 or 12 minutes Default 6 minutes L2786 5 6 Chapter 5 Volumetric Capnography Operator s manual Zero CO This control initiates the sensor zero procedure This procedure needs to be done only when you switch airway adapter types disposable or reusable and as part of the calibration check See the section Zeroing the CAPNOSTAT 5 on page 5 12 Note
176. nalog Inputs The ventilator provides 2 programmable channels for analog signal inputs as shown above Each channel is scalable for the input ranges specified Ranges 0 to 1 VDC 0 to5 VDC 0 to 10 VDC Resolution 0 25 mV for 0 to 1 VDC 1 37 mV for 0 to 5 VDC 2 5mV for 0 to 10 VDC Analog Outputs The ventilator provides 4 signals to the analog output connector 1 Airway Pressure Paw Range 60 to 140 cmH20 Scale 1 cmH20 25 mV Accuracy 50 mV or 5 of reading whichever is greater Zero Offset 1 5 VDC at 0 cmH20 2 Flow Inspiratory Expiratory When selected the ventilator provides a continuous analog voltage representative of inspiratory flow minus expiratory flow Range 300 to 200 L min Adult 120 to 80 L min Pediatric 60 to 40 L min Neonate Scale Factor 1L min 10mV Adult 1 L min 25mV Pediatric 1L min 50mV Neonate Accuracy 10 of reading or 30 mV whichever is greater Zero Offset 3 0 VDC at 0 L min Machine When selected the ventilator provides a continuous analog voltage representative of machine delivered flow Range 0 to 200 L min Adult 0 to 100 L min Pediatric 0 to 50 L min Neonate L2786 B 4 Appendix B Specifications Operator s manual Scale Factor Accuracy Zero Offset Volume Range Scale Factor Accuracy Zero Offset Breath Phase 1 L min 25 mV 1 L min 50 mV Adult Pediatric 1 L min 100 mV Neonate 10 of readi
177. nate Limitations Not active for spontaneous breaths High Peak Pressure This is a high priority audible visual alarm HIGH Ppeax is displayed and a high priority tone sounds whenever the preset High Ppeax threshold is exceeded Inspiration is terminated and circuit pressure is allowed to return to the current set baseline pressure 5 cmH20 Circuit pressure must return to baseline 5 cmH20 before the next breath can be delivered Normal High Ppeax Alarm Alarms if the inspiratory pressure in the patient circuit exceeds the set High Ppeax alarm threshold during the inspiratory phase of a breath except during sigh breath cycles Range 10 to 105 cmH20 Adult Pediatric 10 to 85 cmH20 Neonate Defaults 40 cmH 0 Adult Pediatric 30 cmH20 Neonate Not active for Sigh Breaths Sigh High Ppeax Alarm Alarms if the inspiratory pressure in the patient circuit exceeds the Sigh High Ppeax alarm threshold during a sigh breath cycle Range 1 5 x Normal High Ppeax up to a maximum of 105 cmH20 Active only for Sigh Breaths L2786 AVEA ventilator systems Chapter 7 Alarms and Indicators 7 9 L2786 Note Maximum Circuit Pressure Limit The ventilator has an independent mechanical pressure relief valve which limits the maximum pressure at the patient wye to 125 cmH20 Extended High Peak Pressure This is a high priority audible visual alarm EXT HIGH Ppeax is displayed and a high priority tone sounds if the High Ppeak
178. ne button to the left of the touch screen on the UIM The button is labeled with the icons shown here TRENDS MANEUVER STANDBY amp o000 0O or International English UTILITY Select LOOP from the options that appear Figure 4 4 Screen Selection Choice of Loops The ventilator displays 2 loops in real time selected from the following e Vt Flow Flow Volume Loop Inspiratory flow Volume If proximal flow sensor is used values are based on proximal flow sensor measurements Available for all patients e PAW Vt Airway Pressure Volume loop Active for all patients e PES Vt Esophageal Pressure vs Volume loop This requires the use of an optional esophageal catheter and is active for adult and pediatric patients only e PTR Vt Tracheal Pressure vs Volume loop This requires the use of an optional tracheal catheter and is active for adult and pediatric patients only e Pnsp Vt Inspiratory Pressure vs Volume loop e Pr Vt Transpulmonary vs Volume This requires the use of an optional esophageal catheter and is active for adult and pediatric patients only e PCO Vte Exhaled CO vs Exhaled Vt Note Loops are circuit compliance compensated for pediatric and adult patient sizes L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 5 Using the Freeze Button to Compare Loops Vt ml Flow lpm You can freeze the Loops screen and select a reference loop for comparison Wh
179. nes o 0 Compliance is dependent on the operator IEC 61000 4 11 X se Ur X 4 following recommended charging and 60 dip in U 60 dip in U7 maintenance of the installed battery backup for 5 cycles for 5 cycles 70 Ur 70 Uy 30 dip in U 30 dip in U7 for 25 cycle for 25 cycle lt 5 Uz lt 5 U7 gt 95 dip in U7 gt 95 dip in U7 for 5 seconds for 5 seconds Power frequency 50 60 Power frequency magnetic fields should be at Hz magnetic field level characteristic of a typical location in a 3 A m 3 A m typical commercial or hospital environment NOTE U is the a c mains voltage prior to application of the test level L2786 AVEA ventilator systems Appendix J Electromagnetic Declarations J 3 60601 1 2 IEC 2001 E Table 203 Guidance and manufacturer s declaration electromagnetic immunity The AVEA Ventilator is intended for use in the electromagnetic environment specified below The customer or the user of the AVEA Ventilator should assure that it is used in such an environment Immunity Test IEC 60601 Compliance level Electromagnetic environment guidance Test level Portable and mobile RF communications equipment should be used no closer to any part of the AVEA Ventilator including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance d mlle Conducted RF 3 Vrms 3V
180. ng or 30 mV whichever is greater None 1 00 to 4 00 L 200 to 800 ml 100 to 400 ml 1L V 1ml 5mV 1ml 10 mV Adult Pediatric Neonate Adult Pediatric Neonate 10 of reading or 30 mV whichever is greater 1 000 VDC The ventilator provides a continuous analog voltage representative of breath phase Inspiration 5 VDC Expiration 0 VDC L2786 AVEA ventilator systems Appendix B Specifications B 5 Digital Communication RS 232 Output Sets the RS 232 output format for digital communications via the port labeled MIB The RS 232 output configuration provides the following setting choices Generic This interface is available in AVEA software versions 3 3 and greater The AVEA GSP Interface Kit is part number 16375 and includes a CAT 5 cable and a 9 pin adaptor Select 8 N 1 and Baud Rates of 9600 2400 4800 9600 19200 38400 57600 or 115200 PRESSURE A C ee Generic 8 N 1 9600 cr PRESSURE A C UTILITY 40 Configuration Date Time Monitoring 20 bpm Rate 1 7 6 LE jana 1 9 CR Only 4800 9600 3 15 3 1 0 21 A cmH20 a cmH20 Limin Insp Pres PEEP Flow Trig Fi02 0 35560 265sec 1 7 6 L2786 B 6 Appendix B Specifications Operator s manual or Select CR LF or CR Only PRESSURE A C UTILITY 41 Configuration Input Output mL Vte Analog Input Scale 0 1 vde 0 35 sec Insp Time 2 65sec VueLink Da
181. o a service technician authorized by Cardinal Health The annual maintenance will include the following Replacement of The Air inlet Filter The Oxygen Inlet Filter The Compressor Inlet Filter on compressor equipped models The Compressor Outlet Filter on compressor equipped models The Exhalation Diaphragm At this time the following maintenance will be performed Removal amp replacement of the above items Verification that the following transducers are within calibration specifications Air 02 Blended Gas Expiratory Inspiratory Exhaled Flow delta Wye flow delta Auxiliary Esophageal Replacement of the O2 Sensor Verification Testing to confirm the ventilator is functioning within optimum parameters Screen Calibration Calibration of the Capnostat Battery Performance Vertification Every two years the following is recommended to be replaced Internal Batteries External Batteries L2786 AVEA ventilator systems Chapter 8 Maintenance and Cleaning 8 5 AVEA Maintenance should only be performed by a trained and authorized service technician Cardinal Health will make available to qualified technicians service manuals which include such items as circuit diagrams component parts lists calibration instructions and other information to assist in repair of those parts of the ventilator designated by the manufacturer as repairable items WARNING If a mechanical or electrical problem is reco
182. olled mode If a New Patient is selected the default apnea settings are the same as the factory set default settings for each of the controlled modes Note The current set FiO is delivered during Apnea ventilation 3 30 Chapter 3 Ventilator Operation Operator s manual Standby To initiate Standby press the Screens membrane button on the UIM identified by the icons shown here s SCREENS A 0000 00 or International English The Screen Select box appears Figure 3 23 SCREEN SELECT MAIN LOOP MONITOR TRENDS MANEUVER STANDBY UTILITY Figure 3 23 Screen Select Press STANDBY The following message will display ARE YOU SURE YOU WANT TO STOP VENTILATING THIS PATIENT Figure 3 24 Standby Message L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 31 If you select YES the ventilator will stop ventilating the safety valve will close and the ventilator will supply 2 L min of gas continuously to the patient circuit and will display the message shown in Figure 3 25 STANDBY NOT VENTILATING Resume Figure 3 25 Standby Screen To resume patient ventilation press the Resume button The ventilator will restart ventilation at the most recent settings Do not re connect the patient to the ventilator until the RESUME button has been pressed and ventilation has restarted CAUTION The 2 liters of bias flow which is maintained during standby is intend
183. om date of shipment or 16 000 hours of use whichever occurs first with the following exceptions 1 Components for monitoring of physical variables such as temperature pressure or flow are warranted for ninety 90 days from date of receipt 2 Elastomeric components and other parts or components subject to deterioration over which the Company has no control are warranted for sixty 60 days from date of receipt 3 Internal batteries are warranted for ninety 90 days from the date of receipt The foregoing is in lieu of any warranty expressed or implied including without limitation any warranty of merchantability except as to title and can be amended only in writing by a duly authorized representative of the Company L2786 AVEA ventilator systems Contents Revision HIStory irist aa aiaeei a sau aa aaia enaa iii Warranty esal te ear ar ie FE Erp non EOP ER ae or en Peo iv NOCES iiinis niania toate tte acetate atte laiia neues aiai viii Safety Informati n e an aa anaana aaa X Equipment Symbols irssi aaraa aarge aeaa aa a adaa xii Chapter 1 7 IntrodUCtion iisa aeaa aaar aa 1 1 Chapter 2 Unpacking amp Setup ssssssssssssssresnsnnsnnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnan 2 1 Ventilator Assembly amp Physical SCtup cssssssssssssssessesscestsessssnssseessessessenssessssnssceesseesseeasenssesssensess 2 1 Setting Up the Front of the Ventilator sssssssssssssessssnssssessessesseessesssensscensesesssesssneas
184. ood gas values are correct and press Accept If you need to make a change press Cancel and reenter the blood gas values Once accepted the new calculations populate the last row on the capnometry maneuver screen 5 12 Chapter 5 Volumetric Capnography Operator s manual Zeroing the CAPNOSTAT 5 The CAPNOSTAT 5 must be zeroed when it is connected to the AVEA and monitoring is started It must also be zeroed to adjust the sensor to the optical characteristics when you change airway adapter types single patient use or reusable WARNING Failure to correctly zero the CAPNOSTAT 5 may result in incorrect data being displayed The airway adapter and CO sensor must not be attached to the patient circuit during the zero procedure WARNING The airway adapter and CO sensor must not be attached to the patient circuit during the zero procedure Note The Capnostat must be at operating temperature to be zeroed If required the AVEA will wait up to 120 seconds for the sensor to warm up While the zero procedure is in process all CO2 alarms are turned off The alarms resume when the procedure is complete 1 Attach the end of the CO sensor cable to the connection on the bottom of the AVEA UIM E EtCO SaO w So RS232 MB gt s zp Figure 5 10 Bottom of AVEA UIM Attach the CO sensor to the airway adapter Access the Capnography Utilities by depressing the Screens soft b
185. ooks at the inspiratory flow If the Peak Inspiratory Flow is greater than set peak flow the ventilator determines that the patient is continuing to demand flow and cycles the breath when inspiratory flow falls to 25 of peak inspiratory flow If the Peak inspiratory Flow is equal to the set flow the ventilator determines that there is no continued patient demand and ends the breath as a Volume Control breath Default is on Can be turned off by accessing advanced setting of Peak Flow in Volume Controlled Ventilation 3 18 Chapter 3 Ventilator Operation Operator s manual 2 Pressure breaths which are e Controlled by pressure inspiratory PEEP e Limited by pressure inspiratory PEEP margin e Cycled by time or flow 3 Time Cycled Pressure Limited TCPL breaths available for neonatal patients only which are e Controlled by inspiratory flow e Limited by pressure inspiratory PEEP e Cycled by time flow inspiratory or volume Volume Limit Note TCPL breath type is only available for Neonates This is the default breath type for neonate patients Note The ventilator will not allow the operator to set a Peak Inspiratory Pressure Insp Pres or PSV PEEP or baseline pressure in APRV BiPhasic greater than 90 cmH20 The ventilator will deliver an on screen Pop Up Message stating that the Ppeak gt 90 cmH20 The operator must change the Inspiratory Pressure and or PEEP setting to limit the Po
186. or In order to prevent the risk of excessive enclosure leakage current from external equipment attached to the RS 232 printer and video ports isolation of the protective earth paths must be provided to ensure proper connection This isolation should ensure that the cable shields are isolated at the peripheral end of the cable Cautions L2786 The following cautions apply any time you work with the ventilator Ensure that the voltage selection and installed fuses are set to match the voltage of the wall outlet or damage may result A battery that is fully drained i e void of any charge may cause damage to the ventilator and should be replaced All accessory equipment that is connected to the ventilator should comply with CSA IEC601 UL2601 To avoid damage to the equipment clean the air filter regularly The following cautions apply when cleaning the ventilator or when sterilizing ventilator accessories Do not sterilize the ventilator The internal components are not compatible with sterilization techniques Do not gas sterilize or steam autoclave tubing adapters or connectors in place The tubing will over time take the shape of the adapter causing poor connection and possible leaks DO NOT submerge the ventilator or pour cleaning liquids over or into the ventilator xii Operator s manual Equipment Symbols The following symbols may be referenced on the ventilator or in accompanying documentation Source Compliance
187. or touch the filter medium located inside the filter INSPECTION Inspect for any visible damage to the plastic housing or the folded filter media before use Discard if there is any damage REPLACEMENT AVEA Disposable Exhalation Filter including the drain tube and the pinch clamp are single use items Replace with a new unused filter at each circuit change WARNING Do not attempt to sterilize or reuse this filter Note Dispose used filters in accordance with your institution s protocol Sterilize before nondestructive disposal Follow local governing ordinances and recycling plans regarding disposal or recycling of medical device components Additional Information L2786 Detailed information on the specifications of this assembly can be found in Appendix B Specifications 2 10 Chapter 2 Unpacking amp Setup Operator s manual Attaching the Patient Circuit Adult Circuit using an Active Humidifier Using an active humidifier the adult patient Circuit is set up as shown in Figure 2 16 Attach your humidifier to the upright pole of the AVEA base Adjust the height of the humidifier and the length of the humidifier tubing so that the tubing is relatively straight with no occlusions Adult Circuit without active humidifier Inspiratory limb of Patient Circuit Figure 2 16 Adult Circuit with Active Humidifier The setup for use with a p
188. ose to the level of the terminal bronchioles areas that do not participate in gas exchange Anatomic dead space also includes any mechanical dead spaces added to the ventilator circuit between the CO sensor and the patient At end of each exhalation calculation is carried out equivalent to the graphical method defined by Fowler The fraction of CO in the exhaled gas is considered as a function of volume exhaled phase lll __ Vb Anatomic Using Fowler s nomenclature phase is the initial exhaled volume with constant FCO2 FCO2 during phase is calculated as FI Phase III is the linear part of the capnogram associated with exhalation of gas from the lung gas exchange units This is calculated using linear regression over that part of the capnogram representing 30 to 70 of exhaled CO2 The slope of phase III is calculated as m with offset at the FCO axis FO Shaded areas x and y are equal The volume above the capnogram and below the regression line through phase III is calculated as A Anatomical dead space is defined as that point on the volume axis at which the volumes shaded below and above the curve are equal This is calculated using an algebraic method 2A FO FI FO FI 24 m d ana This parameter is calculated for each breath and then averaged over the same period as VCO If either phase or phase III is ill defined based on variation of slope then anatomical dead space is not
189. p Setup 2 23 L2786 Flow Correction Flow Correction allows for flow correction to BTPS Body Temperature Pressure Saturated or ATPD Ambient Temperature Pressure Dry Default position is BTPS and should be used for all clinical applications ILV Mode e To enable Independent Lung Ventilation and define the Master and Slave ventilators access the Utilities screen from the screens menu Figure 2 32 ILV requires the use of a specially configured accessory cable kit part number 16246 which is available from Cardinal Health e With both ventilators turned off connect the ILV cable PN 16124 to the analog port of each ventilator e Turn on the ventilator to be designated as the Slave e Adjust all primary and advances settings as desired e Power up the Master ventilator e Select Master from the Utilities screen e Adjust all primary and advanced settings as desired e Connect the patient Note Ventilation will not begin until the Master ventilator has been turned on Each ventilator maintains independent settings for Fl02 during independent lung ventilation Close monitoring of set FlO2 on each ventilator is recommended Confirm alarm settings on each ventilator Each ventilator will alarm independently based on alarm settings established for that particular ventilator Apnea ventilation on the Slave ventilator is driven by the apnea ventilation rate of the Master ventilator only Should the ventilato
190. ple is based on the fact that CO2 molecules absorb infrared IR light energy of specific wavelengths with the amount of energy absorbed being directly related to the CO2 concentration When an IR beam is passed through a gas sample containing COz the electronic signal from the photo detector which measures the remaining light energy can be obtained This signal is then compared to the energy of the IR source and calibrated to accurately reflect CO2 concentration in the sample 5 2 Chapter 5 Volumetric Capnography Operator s manual Setup 1 Attach the end of the CO sensor cable to the connection on the bottom of the AVEA UIM labeled EtCOz EtCO Connection Figure 5 1 Bottom of AVEA UIM Note Only capnography cables supplied by Cardinal Health are compatible with the AVEA WARNING Route the sensor cable so as to avoid risk of patient entanglement or accidental extubation Clips are available to secure the cable to the breathing circuit as appropriate 2 Access the setup and utilities controls by pressing the Screens button selecting Utility and selecting the Monitoring tab Screens softkey EZ Figure 5 2 Screens softkey L2786 AVEA ventilator systems Chapter 5 Volumetric Capnography 5 3 3 L2786 Enable CO2 Monitoring by touching the Enable Disable button Configuration Input Output Date Time Monitoring Calibration Disabled lt Check Breath Minute
191. purged G Data dial Changes the values for a selected field on the touch screen H Accept Accepts data entered into a field on the touch screen I Cancel Cancels data entered into a field on the touch screen The ventilator will continue to ventilate at current settings L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 5 J Expiratory Hold K When the EXP HOLD button is pressed at the start of the next breath interval the ventilator will not allow the patient to inspire or exhale for a maximum of 20 seconds adult pediatric for breath rates 20 and less 25 seconds for breath rates greater than 20 or 3 seconds neonate Expiratory Hold is NOT active in TCPL breaths Inspiratory Hold Manual When the INSP HOLD button is pressed once the preset of a volume control or pressure control breath has been delivered the patient will not be allowed to exhale for a maximum of 3 0 seconds 0 1 second L Nebulizer L2786 The ventilator supplies blended gas to the nebulizer port at 10 1 5 psig 0 7 bar when an in line nebulizer is attached and the Nebulizer key is pressed provided that the calculated delivered flow is gt 15 L min Delivery of the nebulized gas is synchronized with the inspiratory phase of a breath and lasts for 20 minutes Press the Nebulizer key a second time to end the treatment prior to the end of the 20 minute period CAUTION Use of an ex
192. r Excessively discharged battery Requires at least 12 hours for full External battery charge Decreased run time on battery Does not run on compressor Auto cycling Vent INOP displa Low gas alarm on compressor Loss of gas alarm Device Error indicator NCPAP Pressure Limit Loose connections Check connections Battery not fully charged Internal battery requires at least 4 hours for full charge External battery requires a minimum of 12 hours for a full charge Defective battery Call technical Service Internal fault Call Technical Service Improper sensitivity settings Check flow and pressure trigger settings Circuit leaks Perform EST and correct leaks as required Bias Flow should be set to approximately 1 5 Im greater than Flow Trigger setting Demand Flow turned off Turn on Demand Flow System fault Call Technical Service Minute volume exceeds 40 L min Reduce minute volume Air Heliox connector not properly Insure proper connection connected Internal fault Call Technical Service Defective sensor Replace sensor Exhalation flow sensor not Check connections connected O sensor connector not Check O sensor connected Defective O sensor Replace O sensor Internal fault Call Technical Service Improper connection sequence External battery connection should be made with AC power disconnected Occlusion of expiratory limb of Check expiratory limb for kinks patient circuit and or water Occlu
193. r External a yellow blinking battery indicator will appear in the lower right hand corner of the LCD screen External Battery Power Indicator The EXT indicator above the battery status indicators is lit whenever the external battery is providing the primary source of power for the ventilator L2786 7 2 Chapter 7 Alarms and Indicators Operator s manual Internal Battery Power Indicator The INT indicator above the battery status indicators is lit whenever the internal battery is providing the primary source of power for the ventilator Battery Status Indicators The battery status indicator shown in Figure 7 1 for the INTernal or optional EXTernal battery will illuminate incrementally depending on the available charge remaining in the battery Note If the ventilator is plugged into the mains power supply and no battery status light is illuminated for the internal battery or optional external battery if equipped the battery should be checked and or replaced Replacement of the Internal battery must be done by a Cardinal Health trained technician LED Indicator Internal Battery NiMH External Battery SLA GREEN At least 90 charge remaining At least 80 charge remaining YELLOW Between 30 and 90 remaining Between 20 and 80 remaining RED Less than 30 charge remaining Less than 20 charge remaining Note When approximately 2 minutes of battery charge remain the ventilator will init
194. r PRVC Vsync breath is terminated Range 0 Off to 45 Default 0 Off Flow cycling is active for Pressure PRVC Vsync or TCPL breaths only Note If flow cycling is active during a PRVC or Vsync breath flow cycling of the breath can only occur if the target tidal volume has been delivered This allows for expiratory synchrony while assuring delivered tidal volume Note If Flow Cycling is active during a pressure control breath monitored airway pressures inspiratory will be higher than set when AAC is active In pediatric and adult ventilation with an inspiratory pressure setting of zero AAC will still provide an elevated airway pressure which will compensate for the resistance of the endotracheal tube Waveform During the delivery of a volume breath flow can be delivered in one of two user selectable waveforms square wave or decelerating wave The default waveform is Decelerating Wave Square Wave Sq With this waveform selected the ventilator delivers gas at the set peak flow for the duration of the inspiration Decelerating Wave Dec With this waveform selected the ventilator delivers gas starting at the peak flow and decreasing until the flow reaches 50 of the set peak flow Demand Flow Enables and disables the Intra Breath Demand system in volume controlled ventilation The default position is on 3 44 Chapter 3 Ventilator Operation Operator s manual Note Should the patient s in
195. rameters described in the previous section are trended as one minute averaged values over a running 24 hour period Trend data is accessed by pressing the screen button on the membrane panel to the left of the touch screen or by pressing the screen indicator in the top center portion of the touch screen display The screen menu will appear Press the TREND button on the screen menu to open the trends screen 40 Vti ml 100 FiO2 30 75 20 50 10 25 0 0 2 4 6 2 4 120 7 Pmean cmH20 80 Rate bpm 90 60 60 40 A S f 10 12 CAE 940 6 09 30 567 09 0 936 22 09 31 524 09 934 22 0932 570 10 93 1 22 0933 5 1 1 92 3 22 Figure 4 19 The Trends Window Note If left open the Trends Window will update every 10 minutes Four histograms and a spreadsheet are displayed on the touch screen Each histogram and column on the spreadsheet can be configured from the list of monitored parameters as well as events Touch the title bar of any histogram or the heading of any column to open a scrollable menu Move through the list by turning the data dial Highlight the item to be displayed and press the highlighted display or the ACCEPT button above the data dial to accept the new item for display Histograms can be scaled by touching either axis With the axis highlighted use the data dial to adjust the scale Touch the axis again or press the ACCEPT button to accept the change To look at histogram or spreadsheet trends over
196. rcuit L2786 E 4 Appendix E Sensor Specifications amp Circuit Resistance Operator s manual Volumetric Capnography Specifications Sensors Sensor Type Mainstream non dispersive infrared single beam optics dual wavelengths No moving parts Sensor Physical Characteristics Weight 25 g 78 g with standard cable and connectors Size 33 mm x 43 mm x 23 mm Cable length 3 m Sensor Compatibility The VIASYS Capnostat 5 is interchangeable between VIASYS equipment only CO Measurement CO Measurement range 0 150 mmHg 0 20 kPa CO2 Measurement Accuracy 2 mmHg for 0 40 mmHg 5 of reading for 41 70 mmHg 8 of reading for 71 100 mmHg 10 of reading for 101 150 mmHg CO Resolution 1 mmHg CO Stability lt 0 8 mmHg over four hours Gas Composition Compensation Oxygen and Helium gas composition Automatic compensation Airway Adapters Adult Pediatric For use with endotracheal tube greater than 4mm ID Single Patient Use Dead space 5 mL Weight 7 7 g Color Clear Infant Pediatric For use with endotracheal tube less than or equal to 4mm ID Single Patient Use Dead space lt 1 mL Weight 9 1 g Color Purple Adult Pediatric For use with endotracheal tube greater than 4mm ID Reusable Dead space 5 mL Weight 12 g Color Black Infant Pediatric Reusable For use with endotracheal tube less than or
197. re 3 19 Volume Apnea Backup settings for APRV BIPHASIC Mode L2786 3 28 Chapter 3 Ventilator Operation Operator s manual VOLUME A C 0 60 MODE SELECT co f Presse prvc AIC A C AIC Ca f Pressure PRVC SIMV SIMV SIMV a O Volume CPAP MODE PSV ACCEPT cmH20 Insp Pres Confirm Apnea Settings MODE SELECT co Pree PRVC AIC A C AIC Volume Ca PRVC SIMV SIMV SIMV a APNEAMODE ETR f aew MODE BiPhasic ACCEPT 10 ml cmH20 Cdyn l l min Sec Volume Peak Flow Confirm Apnea Settings Figure 3 21 Volume Apnea Backup settings for CPAP Mode L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 29 L2786 VOLUME A C Pressure AIC Pressure SIMY 3 Apnea APRV CPAP Mode ressure Settings BiPhasic PSV Accept 150 Vt mL L Total Ve 3 i emH20 j pe S M PEEP aame m cmH20 sec Rate Insp Pres Insp Time Figure 3 22 Pressure Apnea Backup settings for CPAP Mode Apnea ventilation will terminate when one of the following criteria are met e The patient initiates a spontaneous breath e A manual breath is delivered e A timed transition between baseline pressures in APRV BiPhasic To review the Apnea backup settings press the Mode button at any time and select APNEA Settings Note When changing from a controlled mode of ventilation to CPAP PSV or APRV BIPHASIC the default apnea settings will be the same as those set in the contr
198. re they are secure and balloon integrity should be evaluated Note The Balloon Test must be performed without the balloon in the patient Balloon Fill Start Stop When the Start key is actuated the ventilator delivers the volume specified below into the catheter before esophageal pressure measurement commences Adult Catheter 0 5 to 2 5 mL Pediatric Catheter 0 5 to 1 25 mL The ventilator will evacuate and refill the balloon every 30 minutes to maintain measurement accuracy When the Stop key is actuated the ventilator evacuates the balloon prior to removal of the catheter from the patient Note Do Not inflate the balloon until after it has been placed in the patient The balloon should be evacuated prior to removal from patient L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 9 Chest wall Compliance Ccw The preset Chest wall Compliance Ccw is used by the ventilator to calculate work of breathing Range 0 to 300 mL cmH20 Resolution 1 mL cmH20 Default 200 mL cmH20 Alarms All currently available alarms are active during the Esophageal maneuver To Perform Esophageal Maneuvers L2786 Esophageal measurements require the use of an esophageal balloon which can be purchased from Cardinal Health From the Maneuvers Screen menu select Esophageal Before placing the balloon in the patient a balloon test should be performed Connect the esophageal balloon extens
199. reath is increased to include the set volume plus the volume lost due to the compliance effect of the circuit Exhaled volume monitors are adjusted for the compliance compensation volume in all modes of ventilation Range 0 0 to 7 5 ml cmH20 Default 0 0 ml cmH20 Circuit compliance is measured automatically by the ventilator during an Extended Systems Test EST The value cannot be entered manually Note Circuit Compliance is active for set Tidal Volume in volume control ventilation Target Tidal Volume in PRVC and Machine Volume in Adult and Pediatric applications only Although circuit compliance is displayed on the set up screen it is not active for neonatal patients L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 13 L2786 Humidifier You can select active or passive humidification ON active or OFF passive Active humidification assumes 99 RH passive assumes 60 RH when using an HME This feature adjusts the BTPS correction factor to correct exhaled tidal volumes Range Active ON OFF Default Active ON Note Incorrect setting of the Humidification feature will affect monitored exhaled volume accuracy Patient Weight Patient Weight can be set in the following ranges Adult 1 to 300 Kg Pediatric 1 to 75 Kg Neonate 0 1 to 16 Kg Default 1 Kg Patient weight is a variable determined by the clinician and is used for the purpose of displaying monitored volume per unit weight Id
200. red during Heliox therapy Helium has significantly greater thermal conductivity compared to nitrogen oxygen gas mixtures and this could cause difficulty with some heated humidification devices A febrile patient may transfer heat via the gas column to a proximal temperature sensor which could affect the duty cycle of the humidifier and decrease output This could cause desiccation of secretions in the airway Alternately in applications where a heated wire breathing circuit is used this heat transfer from the patient may affect the duty cycle of the heated wire circuit which may result in increased condensation in the breathing circuit The relative settings of some types of humidifiers may need to be reduced to prevent overheating of the breathing gas Note The Oxygen alarm cannot be disabled during Heliox administration Do not operate nebulizer while using heliox 1 6 Chapter 1 Introduction Operator s manual This page intentionally left blank L2786 AVEA ventilator systems 2 1 Chapter 2 Unpacking amp Setup Ventilator Assembly amp Physical Setup Unpacking the Ventilator The AVEA is designed for simplicity of operation and set up It requires minimal assembly on site Items Required for Ventilator Setup L2786 You will need the following to setup your AVEA ventilator Power Source The ventilator operates from a standard 100 110 220 or 240 VAC power source or an optional external 24VDC
201. ress to provide access to other ventilator functions In this event zeroing may then succeed or fail In the event of failure the alarm message CO2 Zero Required displays While CO Zeroing is in progress all CO alarms are disabled These alarms are reenabled and all CO2 monitors are restarted upon completion of the zeroing procedure 5 14 Chapter 5 Volumetric Capnography Operator s manual Checking the Accuracy of the CAPNOSTAT 5 The accuracy of the CAPNOSTAT 5 sensor should be compared against a calibration gas every twelve months 1 Attach the end of the CO sensor cable to the connection on the bottom of the AVEA UIM Figure 5 12 Bottom of UIM Attach the CO sensor to the airway adapter Access the Capnography Utilities by depressing the Screens button selecting Utility and the selecting the Monitoring tab siens 7 Screens softkey K Figure 5 13 Screens Softkey L2786 AVEA ventilator systems Chapter 5 Volumetric Capnography Monitoring tab VOLUME A C Input Output Date Time Monitoring English Master 1 40 ELI Figure 5 14 Configuration Tab in Utility Screen 4 Follow the procedure Zeroing the CAPNOSTAT 5 on page 5 12 Press Continue when the procedure is complete 5 Press Calibration Check and then Continue 6 Set the gas temperature setting to that of the calibration gas typically room temperature CO2 Calibration Check 5 10 Co Gas Temp
202. rimary Controls which feature an advanced setting will display a 8 yellow triangle to the right of the control name BPM CmH20 Rate Insp Pres Figure 3 30 Advanced Settings indicator Note Not every primary control will have an associated advanced setting 3 40 Chapter 3 Ventilator Operation Operator s manual Table 3 4 Controls and Advanced Settings Associated with Breath Type amp Mode BREATH TYPE VOLA C VOL SIMV amp MODE PRIMARY CONTROLS RATE bpm PRES PRES PRVC APRV TCPL Alc SIMV PRVC A C SIMV CPAP PSV BIPHASIC TCPL A C SIMV Apnea Apnea Mode Mode VOLUME Apnea Apnea ml Mode Mode INSP PRES k Apnea Apnea cmH20 Mode Mode PEAK FLOW i Apnea Apnea Limin Mode Mode INSP TIME Apnea Apnea sec Mode Mode INSP PAUSE gt Apnea Apnea sec Mode Mode PSV cmH20 PEEP cmH20 FLOW TRIG Limin OXYGEN 02 PRES HIGH cmH20 TIME HIGH sec re a ee a ee ee ee ae sec eer ee ee Ee ee ee cmH20 ADVANCED Mach vol Insp rise Vol limit Vol limit Vol limit Vol limit Vol limit SETTINGS Vsync Vsync rise vol Vol limit Bias flow PSV rise PSV rise PSV rise Flow Flow AVAILABLE rise Sigh Vol limit Insp rise Pres trig PSV cycle PSV cycle PSV cycle cycle cycle WITHIN EACH Sigh Waveform Insp rise Flow Vol Limit PSV PSV Tmax PSV Bias flow PSV
203. rm silence button will not prevent the audible alarms sounding again later for certain alarm conditions Alarm Reset Cancels the visual indicator for alarms that are no longer active L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 3 C L2786 Alarm Limits Opens the alarm limits screen for data entry or adjustment Toggles the screen on and off Note Pressing the Freeze button while the Alarm Limits window is open will automatically close the window and freeze the graphics Manual Breath Pressing this button during the expiration phase of a breath delivers a single mandatory breath at current ventilator settings No breath is delivered if the key is pressed during inspiration Note The Manual Breath button is not active in APRV BIPHASIC Suction LED Pressing this button initiates a Disconnect for Suction maneuver The ventilator will e Enable an Increase O2 maneuver for 2 minutes see Increase O2 below e While the circuit disconnect alarm is active the ventilator will stop cycling and set a bias flow The ventilator will automatically detect the patient upon reconnection and resume normal ventilation e Silences alarms for 120 seconds If the SUCTION key is pressed again during the 2 minutes that the disconnect for suction maneuver is active the maneuver will be cancelled Increase 0 When this key is pressed the ventilator increases the oxy
204. rminated Range 5 to 45 Default 25 Adult Pediatric 10 Neonate PSV Tmax Controls the maximum inspiratory time of a pressure supported breath Range 0 20 to 5 00 seconds Adult Pediatric 0 15 to 3 00 Neonate Default 5 00 seconds Adult 0 75 seconds Pediatric 0 35 seconds Neonate T High Sync T High Sync establishes the length of respective trigger Sync window while in Time High Transition from Pressure High to Pressure Low occurs with the first end of inspiration detected after the T High Sync window opens Range 0 50 in 5 increments of set T High Default Adult and Pediatric 0 Infant Not Applicable T High PSV Pressure Support breaths are available during Time High in APRV BiPhasic by activating T High PSV If T High PSV is activated during Time High the ventilator will deliver the same PSV level for both Pressure Low and Pressure High Range Pressure Support Adult and Pediatric 0 90 CcmH20 Infant Not Applicable Not to exceed a PIP gt 90 cmH20 Default Adult and Pediatric Off Infant Not Applicable T Low Sync T Low Sync establishes the length of respective trigger Sync window while in Time Low The ventilator synchronizes the change from Pressure Low to Pressure High with the detection of inspiratory flow or the first inspiratory effort detected within the T Low Sync window Range 0 50 in 5 increments of set T Low Default Adult and Pediatric 0 Infant Not Applicable Note P
205. rmination and Limit secondary breath termination Mandatory Breaths Mandatory breaths can be triggered by the machine the patient or the operator There are 4 mandatory breath types delivered by the AVEA 1 Volume breaths which are e Controlled by flow inspiratory e Limited by pre set volume or maximum inspiratory pressure e Cycled by volume flow and time Note The Volume Controlled breath is the default breath type for adult and pediatric patients The Intra Breath Demand System in Volume Ventilation AVEA features a unique intra breath demand system in Volume Controlled ventilation designed to provide additional flow to the patient during periods of demand AVEA measures the Peak Inspiratory Pressure Ppeak every 2 milliseconds throughout the breath cycle and sets a virtual Pressure Support Target of the greater of PEEP 2 cmH20 or Ppeak 2 cmH20 The minimum virtual Pressure Support level is set PEEP 2 cmH20 The maximum is 2 times the set PEEP Simultaneously the ventilator monitors and compares the Ppeak measurement to its previous value Should the Ppeak decrease by the 2 cmH 0 the ventilator will recognize the patient demand and automatically switch over to deliver a Pressure Support breath at the virtual Pressure Support Target This allows flow to exceed the set Peak Flow thereby meeting the patient s demand Once the set tidal volume has been delivered the ventilator l
206. rs become disconnected during ILV only the Master ventilator will alarm for the ILV Disconnect condition The Slave ventilator will alarm for Apnea and begin apnea ventilation at its own active settings WARNING DO NOT attempt to connect a standard DB 25 cable to this receptacle This could cause damage to the ventilator A specially configured cable is required for ALL features associated with this connector Contact Technical Support Setting up Independent Lung Ventilation ILV The AVEA has a 25 pin receptacle on the rear panel Figure 2 33 to allow for Independent Lung Ventilation ILV with another AVEA The output for ILV provides a 5VDC logic signal synchronized to the breath phase of the master ventilator Table 2 1 at the end of this section details the relevant pins for the signals carried by this connector Note This connector also carries the Analog Input and the Analog Output signals Refer to Appendix B Specifications for Analog Output Pressure cmH20 mv flow ml min mv and Volume ml mv conversions 2 24 Chapter 2 Unpacking amp Setup Operator s manual ILV connector pin configuration To connect two AVEA ventilators together for independent lung ventilation function the cable must be wired so that the ILV input the slave on one AVEA is connected to the ILV output the master on the other AVEA As shown in Figure 2 33 below the ILV slave is pin 18 and the ILV master is pin
207. rway and esophageal baseline pressures Vt Ciune 7 where dPetat tp Pprat aw Pes PEEPaw PEEPes PLAT TP Range 0 to 300 mL cmH20 Resolution 1 mL cmH20 Note Requires an Inspiratory Hold maneuver and an esophageal balloon catheter Accuracy 10 Appendix G Advanced Pulmonary Mechanics Monitored Parameters Operator s manual Compliance Ratio C2 C Compliance Ratio C2 C is the ratio of the dynamic compliance during the last 20 of inspiration C20 to the total dynamic compliance C Range 0 00 to 5 00 Resolution 0 01 Accuracy 10 Respiratory System Resistance Rrs Respiratory System Resistance Rrs is the total resistance during the inspiratory phase of a breath Respiratory System Resistance is the ratio of the airway pressure differential peak plateau to the inspiratory flow 12 ms prior to the end of inspiration Range 0 to 100 cmH20 L sec Resolution 0 1 cmH2O L sec Limitation Active for volume breaths only Note Requires an Inspiratory Hold maneuver Accuracy 10 Peak Expiratory Resistance Reeax The ventilator shall be capable of calculating and displaying the Peak Expiratory Resistance Rpeax which is defined as the resistance at the time of the Peak Expiratory Flow PEFR PEFR Rpeak PEFR Range 0 0 to 100 0 cmH20 L sec Resolution 0 1 cmH 2O L sec Accuracy 10 L2786 AVEA ventilator systems Appendix G Advanced Pulmonary Mechanics Mon
208. ry fuses are 10A 250V 5 x 20 mm fast blow type The fuse for the optional external battery is located on the back panel next to the external battery connector and is replaceable The fuse for the internal battery is located to the right of the UIM connection To remove fuses carefully unscrew with a flat blade screwdriver and pull out the fuse holder External Battery Fuse Holder External Battery Connector Figure 8 3 External Battery Connector amp Fuse WARNING To avoid fire hazard use only the fuse specified in the ventilator s parts list or one that is identical in type voltage rating and current rating to the existing fuse L2786 AVEA ventilator systems Chapter 8 Maintenance and Cleaning 8 9 Mains Fuses The main AC power fuses are housed within the power entry module located on the back panel They are slow blow type Check that the correct voltage for your mains supply is showing through the window in the power entry module Table 8 1 Mains fuses Line Voltage Fuse Amperage 100 120VAC 250V 6 35 x 31 75mm 3 2A 230 240VAC 250v 6 35 x_31 75mm 1 54 Replacing a Mains Electrical Fuse WARNING Ensure that the mains power cord is unplugged before attempting to remove or replaces fuses To replace mains electrical fuses 1 Unplug the ventilator from the mains AC power source and unplug the power cord from the power entry mod
209. s e Standard SVGA Monitor Cable Length 2 meters Use of other cables may result in increased emissions or decreased immunity See Tables 201 202 203 and 205 for further information regarding the AVEA Ventilator and EMC MRI Notice This equipment contains electromagnetic components whose operation can be affected by intense electromagnetic fields Do not operate the ventilator in a MRI environment or in the vicinity of high frequency surgical diathermy equipment defibrillators or short wave therapy equipment Electromagnetic interference could disrupt the operation of the ventilator Intended Use Notice The AVEA ventilator systems are designed to provide ventilator support for the critical care management of infant pediatric or adult patients with compromised lung function They are intended to provide continuous respiratory support in an institutional health care environment e g a hospital They should only be operated by properly trained clinical personnel under the direction of a physician Regulatory Notice Federal law restricts the sale of this device except by or on order of a physician L2786 AVEA ventilator systems ix Classification Type of Equipment Medical Equipment Class 1 type B Adult Pediatric Infant Lung Ventilator Declaration of Conformity Notice This medical equipment complies with the Medical Device Directive 93 42 EEC and the following Technical Standards to which Conformity is declared O
210. s breaths CPAP PSV Continuous Positive Airway Pressure Demand Breath with Pressure Support Ventilation PRVC A C Pressure Regulated Volume Controlled breath with Assist Ventilation PRVC SIMV Pressure Regulated Volume Controlled breath with Synchronized Intermittent Mandatory Ventilation SIMV and an adjustable level of pressure support for spontaneous breaths APRV Spontaneous demand breath at two alternating baseline pressure levels or controlled ventilation BIPHASIC cycled by time Neonatal Ventilation Modes The following table shows the breath types and ventilation modes available for Neonatal patients Table 3 2 Neonatal Displayed Modes Displayed Mode Description Volume A C Volume breath with Assist ventilation Default for adult and pediatric patients Pressure A C Pressure breath with Assist ventilation Volume SIMV Volume breath with Synchronized Intermittent Mandatory Ventilation SIMV and an adjustable level of pressure support for spontaneous breaths Pressure SIMV Pressure Breath with Synchronized Intermittent Mandatory Ventilation SIMV and an adjustable level of pressure support for spontaneous breaths TCPL A C Time Cycled Pressure Limited breath with Assist ventilation Default for neonatal patients TCPL SIMV Time Cycled Pressure Limited breath with SIMV and an adjustable level of pressure support for spontaneous breaths CPAP PSV Continuous Positive Airway Pressure Demand Breath with
211. sation will still provide an elevated airway pressure which will compensate for the resistance of the endotracheal tube When turned on the Artificial Airway Compensation indicator will appear in all modes of ventilation even though the function may not be active i e Volume Controlled Breaths This is to alert you to the fact that Artificial Airway Compensation will become active if a Pressure Support or combination mode e g Volume Control SIMV is selected Range Off On Default Off Available in all patient sizes 1 Estimation of Inspiratory Pressure Drop in Neonatal and Pediatric Endotracheal Tubes by Perre Henri Jarreau American Physiological Society 1999 L2786 AVEA ventilator systems Chapter 1 Introduction 1 3 Full range of Patient Size You can select a patient size of Adult Pediatric or Neonate Once the selection is made the ventilator offers only those parameters which are available for your selected patient size Non Invasive Ventilation The ventilator can perform non invasive ventilation with a standard dual limb circuit Leak compensation should be turned on when using this feature To turn leak compensation on use the touch screen control displayed in the Ventilator Set Up Screen Note Non invasive ventilation requires the use of a snug fitting mask with no bleed holes Excessive leaks around the mask may result in false triggering of the ventilator or assertion of disconnect alarms Leak Co
212. screen 3 9 patient size 1 3 patient size indicators 3 5 patient size select screen 3 10 patient triggered breaths 3 19 peak Expiratory flow rate 4 22 D 2 peak flow 3 33 peak Inspiratory flow rate 4 22 D 2 peak inspiratory pressure 4 21 D 2 PEEP 3 18 3 19 3 33 3 35 3 37 3 44 4 22 7 6 7 8 7 9 7 12 D 2 K 1 percent leakage 4 21 D 1 percentage of oxygen 4 22 D 2 plateau pressure 4 22 D 2 positive end expiratory pressure 3 37 4 22 D 2 power cord 2 32 power on indicator 7 1 power source 2 1 pres high 3 33 3 38 pres low 3 33 pres trig 3 44 pressure breaths 3 18 pressure high control 3 38 pressure low control 3 39 pressure regulated volume control breaths 3 18 pressure support ventilation 3 25 preventive maintenance 8 4 primary breath controls 3 33 3 35 breath rate 3 35 flow trigger 3 38 inspiratory pause 3 36 inspiratory pressure 3 35 Index 4 Index Operator s manual inspiratory time 3 36 PEEP 3 37 pressure high 3 38 pressure low 3 39 pressure support 3 36 tidal volume 3 35 time high 3 38 time low 3 39 printing 4 3 protective ground connection 2 32 PSV 3 33 PSV breath 3 19 PSV control 3 36 PSV cycle 3 19 3 46 PSV rise 3 45 PSV Tmax 3 19 3 46 R rapid shallow breathing index 4 21 D 2 rate 3 33 rear panel diagram 2 18 reference loop 4 5 remote nurse call system 2 31 replaceable f
213. selectable time VCO2 Average 3 6 9 12 minutes Pore FCO al wye Ty V CO Appendix l Volumetric CO2 Calculations Operator s manual FeCO Percentage of carbon dioxide in the exhaled gas reported by the CO sensor at the wye This value is used in the dead space calculations but is not displayed FeCO VCO V PeCO Mean exhaled partial pressure of carbon dioxide in the exhaled gas reported by the CO2 sensor at the wye This value is used in the dead space calculations but is not displayed PeCO FeCO x P PEEP Bar Physiologic Dead Space Vd phy Comprises anatomic dead space see below as well as the volume of the respiratory zone respiratory bronchioles alveolar ducts and alveoli not participating in gas exchange The classic Bohr Enghoff equation is used to calculate physiologic dead space This method uses arterial CO PaCOz2 as an estimator for alveolar CO PACOz Pos ry 7 1 aCO2 Physiologic Dead Space Tidal volume ratio Vd phy Vt Used to calculate the ratio of the tidal volume not participating in gas exchange wasted ventilation Vi E La yhy 1 c02 y pee P l t aCO2 2 Enghoff H Volumen inefficax Bemerkungen zur Frage des schadlichen Raumes Upsalla Lakareforen Forhandl 1938 44 191 218 L2786 AVEA ventilator systems Appendix l Volumetric CO2 Calculations 1 3 Anatomic Dead Space Vd ana Total volume of the conducting airways from the n
214. sor is available for use with patients whose flow requirements fall within the range of 1 2 180 L min Detailed information on the specifications of each flow sensor can be found in Appendix E Sensor Specifications and Circuit Resistance Chapter 2 Unpacking amp Setup Operator s manual Variable Orifice Flow Sensor Variable Orifice sensors attach to the receptacle on the front panel of the ventilator circled in dark blue and marked with the icon shown here vane po Re v This is a locking connector To attach first pull back the plastic locking collar then push firmly onto the ventilator receptacle Then push the locking collar forward to lock the flow sensor in place Retractable plastic collar Figure 2 21 Variable Orifice Flow Sensor Attachment To disconnect first retract the plastic collar then firmly pull the connector away from the ventilator Do not pull up or down as this can damage the connector CAUTION Fully retract the plastic locking collar before attaching these connectors Failure to do this can cause damage to the connector L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 15 Attaching a Nebulizer L2786 You can use an in line nebulizer with the AVEA ventilator see Chapter 3 Ventilator Operation The nebulizer is synchronized with inspiration delivers gas at the set F102 and is active for 20 minutes Attach the ne
215. spiratory demand be sustained beyond the controlled inspiratory time plus the minimum expiratory time with the demand system turned off auto cycling or double cycling may occur This is the result of the patient demanding more flow than available resulting in a breath trigger after the minimum expiratory time This may be resolved by increasing the inspiratory flow rate to meet the patients demand or turning the demand system back on Sigh The ventilator delivers sigh volume breaths when this setting is ON A sigh volume breath is delivered every 100 breath in place of the next normal volume breath Range Off On every 100 breaths Sigh Volume 1 5 times set tidal volume Sigh Breath Interval sec Set Normal Breath Interval x 2 Assist mode or set Normal Breath Interval SIMV mode Default Off Sigh breaths are only available for Volume breaths in Assist and SIMV modes for adult and pediatric patients Bias Flow The Bias Flow control sets the background flow available between breaths Additionally this control establishes the base flow that is used for flow triggering Range 0 4 to 5 0 L min Defaults 2 0 L min Note To ensure adequate bias flow for inspiratory triggering the bias flow setting should be at least 0 5 liters per minute greater than the flow trigger threshold Consult the ventilator circuit manufacturer to ensure that bias flow setting is sufficient to prevent overheating of the ventilator circuit Pres Tr
216. stem is the difference between the baseline airway pressure PEEPaw and the airway pressure when the patient initiates a breath Paw star AutoPEEPes PEEPes Pes start PEEPaw Paw start Range 0 to 50 cmH20 Resolution 1 cmH20 Note Requires an esophageal balloon catheter Accuracy 2cmH20 or 5 whichever is greater Transpulmonary Pressure Plateau Pip Plat The ventilator is capable of calculating and displaying the Transpulmonary pressure during an inspiratory hold which is the difference between the airway plateau pressure Prat aw and the corresponding esophageal pressure PtpPlat Pprat aw Pes Range 60 to 120 cmH20 Resolution 1 cmH20 Accuracy 2cmH20 or 5 whichever is greater Note Requires an inspiratory hold and an esophageal catheter L2786 Appendix G Advanced Pulmonary Mechanics Monitored Parameters Operator s manual Transpulmonary Pressure AutoPEEP Ptp PEEP Transpulmonary pressure AutoPEEP PipPEEP is the difference between the corresponding airway and esophageal pressures at the end of the expiratory hold during an AutoPEEP maneuver PipPEEP Paw Pes at the end of an expiratory hold Range 60 to 120 cmH20 Resolution 1 cmH20 Accuracy 2 cmH20 or 5 whichever is greater Note Requires an expiratory hold and an esophageal catheter Maximum Inspiratory Pressure MIP Maximum Inspiratory Pressure MIP is the maximum negative airway pr
217. t can be used as an alternative for the AVEA reusable filter assembly reusable filter a collector vial a water trap and a cartridge component The AVEA reusable filter assembly is not required when using the Disposable Expiratory Filter Water Trap Figure 2 9 AVEA Disposable Expiratory Filter Water Trap 1 Locate the metal locking lever on the front lower left side of the ventilator then rotate the lever outwards to a fully open position AM Figure 2 10 Inserting the Filter Water Trap combination 2 Insert the AVEA Disposable Expiratory Filter into the filter cavity with the orientation as shown in Figure 2 10 Make sure the filter is fully inserted into the filter cavity before closing the lever L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 7 3 L2786 Close the locking lever completely to secure the filter in the ventilator well Figure 2 11 Closing the locking lever After you close the locking lever the filter is ready for use Figure 2 12 Completed installation of Filter Water Trap combination WARNING Incomplete insertion of the AVEA Disposable Expiratory Filter may cause misalignment of the filter seal which will result in patient circuit leakage Note The lever closes without great difficulty if the filter is fully inserted into the filter cavity WARNING The locking lever must be closed completely
218. t the peripheral end of the cable See Appendix B Specifications regarding connections and communications L2786 2 18 Chapter 2 Unpacking amp Setup Operator s manual Setting Up the Rear of the Ventilator Figure 2 25 Rear panel AC power module H Oxygen hose connection UIM connection a External battery connector Analog input output ILV External battery fuse A B C D Power ON OFF Switch Internal battery fuse E F G Nurse call system connection E Air Heliox smart connector E Oxygen sensor L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 19 Connecting the Oxygen Sensor 02 Cell The oxygen sensor cell is located on the rear panel between the two gas fittings The oxygen sensor cable emerges from the rear panel directly above the sensor Carefully align and then gently push the connector onto the oxygen sensor until it seats When a good connection has been made slide the protective cover down gai JN and push over the sensor Figure 2 26 Connecting the O2 Sensor Connecting Gas Fittings The Smart Air Fitting There are two gas connections on the rear panel of the ventilator The one on the left of Collar the panel is for attaching the Air or Heliox gas source The smart connector fitting type shown here is CGA DISS type body No 1160 for air with an integral water trap filter To prevent the entry of moisture into the ventil
219. t value and clear the alarm by pressing the reset button Set the High Vt alarm setting to a value below the set Vt on your ventilator Verify that the High Vt alarm activates Return the alarm setting to its default value and clear the alarm by pressing the reset button Set the Low Vt alarm setting to a value above the set Vt on your ventilator Verify that the Low Vt alarm activates after the number of breaths set in the Utility screen for VTE sensitivity Return the alarm setting to its default value and clear the alarm by pressing the reset button Set the High Rate alarm to a value below the default control setting for rate on your ventilator Verify that the alarm activates Return the alarm to its default setting and clear the alarm by pressing the reset button Occlude the inspiratory limb of the patient circuit Verity that the Circuit Occlusion alarm activates CAUTION Although failure of any of the above tests will not prevent the ventilator from functioning it should be checked to make sure it is operating correctly before use on a patient L2786 AVEA ventilator systems Default Settings for Adult Pediatric and Neonate The Default settings are the operational settings that take effect when you press the New Patient button on power up Ventilation Setup Chapter 2 Unpacking amp Setup 2 37 L2786
220. ta points on waveform loop or trend screens To restore the screen to active press the Freeze button a second time Figure 3 2 shows a flow volume loop in freeze mode The cursors trace the frozen loop curve along an X Y plot line The values along the curve of the loop are displayed as shown below Flag showing X and Y values at various points along the loop tracing Dashed Cursor Line Flow Volume Loop Tracing Cursor currently overlays the X axis at Zero Figure 3 2 Flow Volume Loop in Freeze Mode 3 8 Chapter 3 Ventilator Operation Operator s manual Screens Opens the Screen Selection box Figure 3 3 You can also open this by pressing the Screen indicator in the top center of the touch screen Note Pressing the Screens button a second time closes the window SCREEN SELECT TRENDS MANEUVER STANDBY UTILITY Figure 3 3 Screens Selection Box Main Returns the display to the main screen Alarm Status LEDs The Alarm status indicators at the top right of the UIM flash red or yellow to indicate a high or medium priority alarm see Chapter 5 Volumetric Capnography L2786 AVEA ventilator systems Chapter 3 Ventilator Operation Patient Setup Patient Select Screen The Patient Select screen allows you to choose to resume ventilation of the current patient RESUME CURRENT or select NEW PATIENT to reconfigure ventilator settings PATIENT SELE
221. tact your Cardinal Health representative Do NOT attempt to replace the battery yourself The battery should only be replaced by a qualified technician Precedence of power use The sequence in which the power sources are used by the ventilator is AC External Battery if installed Internal Battery CAUTION Do not store the ventilator in hot areas for prolonged periods of time Temperatures above 80 F 27 C can shorten battery life Failing to charge the ventilator while in storage may also shorten battery life CAUTION When the integrity of the external power ground conductor arrangement is in doubt operate the ventilator from its internal battery or the optional external battery Note Refer to the Service Manual for battery maintenance and testing procedures L2786 AVEA ventilator systems Chapter 8 Maintenance and Cleaning 8 7 Battery Status Battery status indicators showing the state of charge of the internal and external batteries appear on the front panel of the ventilator Figure 8 2 L2786 Green Yellow Red T Figure 8 2 Front Panel Display Area Comprehensive model shown If the battery charge is allowed to drop below the low range of the battery monitor a battery status indicator LED may no longer be displayed The unit should be plugged into the AC power supply to allow th
222. te Time Monitoring Analog Output Type Wye Flow RS 232 Output Genie pni poo CR Only 3 1 0 21 Ca cmH20 Limin PEEP Flow Trig Fi02 AVEA software versions 3 1 and greater can be interfaced with the Phillips Vue Link system The part number of the Vue Link CAT 5 serial cable and adaptor is 16337 PRESSURE A C UTILITY 40 Configuration Input Output mL Vte Analog Input Scale 0 1 vde 0 35 sec Insp Time 2 65sec T 1 76 Date Time Monitoring Analog Output Type Wye Flow RS 232 Output VueLink 3 U 1 0 21 Limin cmH20 PEEP Flow Trig Fi02 L2786 AVEA ventilator systems Appendix B Specifications B 7 VOXP Ventilator Open XML Protocol AVEA software versions 3 7 and greater support VOXP The AVEA VOXP Interface kit is part number 16375 and includes a CAT 5 cable and a 9 pin adaptor Select either 8 N 1 7 N 1 7 E 1 or 7 0 1 and Baud Rates of 9600 19200 38400 57600 115200 PRESSURE A C UTILITY 41 Configuration Input Output Date Time Monitoring mL Vte Analog Input Scale Analog Output Type 20 z vde bpm Rate 1 7 6 20 Ji 15 0 35 1 0 21 e E rd bpm cmH20 sec cmH20 Lmin Rate Insp Pres Insp Time Flow Trig Fi02 0 35sec 265sec 1 7 6 PRESSURE A C UTILITY 41 Configuration Input Output Date Time Monitoring Analog Input Scale Analog Output Type 0 1 0 5 Wye vde Flow RS 232 Output co
223. ternal flow source to power the nebulizer is not recommended WARNING Using the nebulizer may impact delivered tidal volumes Note Do not operate the nebulizer while using heliox Patient Size e The Patient Size Indicators for Adult Pediatric and Neonate at the bottom of the UIM show which T g patient size is currently selected These LED indicators have no associated membrane button on the UIM Note The ventilator will not allow patient size changes when the active mode of ventilation is not available in the new patient size selection The ventilator will display a message instructing you to first change the ventilation mode For example in neonatal ventilation with TCPL active you cannot change to a pediatric or adult patient size without first changing the mode to one available for those patients The ventilator will also not allow size changes if Machine Volume is active A message displays indicating that Machine Volume must first be turned off before making a patient size change 3 6 Chapter 3 Ventilator Operation Operator s manual Panel Lock LED The LOCK key disables all front panel and screen controls except MANUAL BREATH Suction 02 ALARM RESET ALARM SILENCE and LOCK Print The PRINT key outputs the contents of the currently displayed screen to a suitably connected parallel printer Set up Opens the ventilator Setup screen Note Pressing the
224. ters of water pressure The maximum tidal volume delivered in a single breath is determined by the Volume Limit setting L2786 AVEA ventilator systems Chapter 3 Ventilator Operation 3 19 L2786 The test breath sequence is initiated when any of the following occur e Entering the Mode PRVC e Changing the set tidal volume while in PRVC e Reaching the Volume Limit setting e Delivered tidal volume gt 1 5 times the set volume e Flow termination of the test breath e Exiting Standby e Activation of any of the following alarms High Peak Pressure Alarm Low Peak Pressure Alarm Low PEEP Alarm Patient Circuit Disconnect Alarm Time Limit lE Limit Note If flow cycling is active during a PRVC or Vsync breath flow cycling of the breath can only occur if the target tidal volume has been delivered This allows for expiratory synchrony while assuring delivered tidal volume Note Demand Flow is active for all mandatory breaths The maximum peak inspiratory pressure achievable by the ventilator is limited by the high peak pressure alarm setting Demand Breaths All demand breaths are patient triggered controlled by pressure and flow or time cycled Demand breaths can be either pressure supported PSV or spontaneous All demand breaths are accompanied by the yellow patient demand indicator which flashes in the upper left of the screen 1 PSV Pressure Support Ventilation A PSV breath is a demand breath
225. th and the sensitivity of the ventilator s demand system Ccw Chest wall Compliance Ccw is the ratio of the tidal volume exhaled to the Delta Esophageal Pressure dPes Ciune Lung Compliance C une is the ratio of the tidal volume exhaled to the delta transpulmonary pressure Ptp Plat Transpulmonary pressure during an inspiratory hold MIP Maximum Inspiratory Pressure is the maximum negative airway pressure that is achieved by the patient during an expiratory hold maneuver P100 Respiratory Drive P100 is the negative pressure that occurs 100 ms after an inspiratory effort has been detected nCPAP Mean airway pressure while in nCPAP mode CPAP Flow Mean inspiratory flow while in nCPAP mode EtCO2 Peak expired CO2 as measured and reported by the CO2 sensor in the aiway EtCO2 is measured for each breath Display is either a breath by breath or averaged measurement Vco2 The amount of CO2 eliminated every minute This is calculated over each minute and then averaged over the set VCO2 averaging time VtCO2 The amount of CO2 exhaled per breath It is measured for each breath and then averaged over the set VCO2 averaging time Vdana The volume of dead space in the patient s airway Anatomical dead space is measured for each breath This value is averaged over the set VCO2 averaging time VdanailVt Vd Vt ana is averaged over the set VCOz averaging time L2786 4 24 Chapter 4 Monitors Displays and Maneuvers Operator s manual Even
226. the right of the user interface marked with the icon shown here The Alarm Limits screen will appear Figure 7 2 To set the limits for an alarm press the touch screen immediately over the alarm control The control will highlight change color on the screen PRESSURE A C ie 40 7 Paw cmH20 20 4 2 4 6 8 10 12 mam 40 Flow L min 75 0 300 0 0 5 0 30 1 20 1 30 60 C20 15 0 35 3 1 0 aon a gwo Lmin cmH20 amp sec Insp Pres Insp Time Flow Trig Figure 7 2 Alarm Limits Screen ACCEPT CANCEL Figure 7 3 Control Knob and Accept Cancel Softkeys L2786 7 6 Chapter 7 Alarms and Indicators Operator s manual With the control selected rotate the large data dial below the touch screen until the control reaches the setting you require To accept the new setting either press the touch screen over the control again or press the ACCEPT button Note Red indicators appearing on the primary controls display the relative alarm settings of any associated alarm Alarm Silence You can disable the audible alarm for 2 minutes 1 second by pressing the Alarm Silence key Pressing the Alarm Silence key again before the 2 minute period is up will cancel the silence This feature is functional for all alarms with the exception of the Vent Inop alarm which cannot be silenced Note The activation of the auditory alarm silence button will not prevent the subsequent activat
227. ther equipment NOTES identify supplemental information to help you better understand how the ventilator works Warnings Warnings and Cautions appear throughout this manual where they are relevant The Warnings and Cautions listed here apply generally any time you operate the ventilator e The AVEA Ventilator is intended for use by a trained practitioner under the direction of a qualified physician e When the ventilator is connected to a patient a trained health care professional should be in attendance at all times to react to an alarm or other indications of a problem e Alarm loudness must be set above ambient sound in order to be heard e Always have an alternate means of ventilation available whenever the ventilator is in use e The operator should not touch the electrical connectors of the ventilator or accessories and the patient simultaneously e Due to possible explosion hazard the ventilator should not be used in the presence of flammable anesthetics e An audible alarm indicates an anomalous condition and should never go unheeded e _ Anti static or electrically conductive hoses or tubing should not be used within the patient circuit e Ifa mechanical or electrical problem is recognized while operating the ventilator the ventilator must be removed from use and referred to qualified personnel for servicing Using an inoperative ventilator may result in patient injury e When a low gas supply alarm occurs the oxygen concentratio
228. three significant digits whichever is greater L2786 AVEA ventilator systems Chapter 5 Volumetric Capnography 5 7 CO VtCO The amount of CO exhaled per breath VtCO2 is measured for each breath and then averaged over the set VCO2 Averaging time Range 0 299 mL Resolution 0 1 mL or three significant digits whichever is greater Anatomical Dead Space Vd ana Volume of dead space in the patient s airway Anatomical dead space is measured for each breath This value is averaged over the set VCO2 averaging time Range 0 999 mL Resolution 0 1 mL or three significant digits whichever is greater Anatomical Dead Space Tidal Volume Ratio Vd Vt ana Vd Vt ana is averaged over the set VCO2 averaging time Range 0 99 Resolution 1 Note VCO2 VtCO2 Vd ana and Vd Vt ana require flow to be measured by a proximal flow sensor at the wye or circuit compliance compensation to be active If a proximal flow sensor or circuit compliance compensation are not used the AVEA displays in those fields Note An arterial blood gas sample is required to calculate VA Vd phy Vd Vt phy Vd alv Ol and P F These values are available at the Capnography Maneuver screen Alveolar Ventilation VA Alveolar Ventilation is the volume of gas participating in gas exchange per minute Range 0 99 9 L min Resolution 0 01 L min or three significant digits whichever is greater Physiologic Dea
229. tilator These settings will be used in the event of a loss of signal from the Master ventilator WARNING Since the master ventilator controls the breath rate for both ventilators care should be taken when setting the other independent breath controls for the slave ventilator to ensure sufficient time is allowed for exhalation to occur If the cable connecting the master and slave ventilators becomes detached the slave ventilator will alarm for loss of signal In this event only the master ventilator will continue to provide ventilation at the current settings The slave ventilator will begin apnea ventilation after its apnea timer has elapsed at its current apnea ventilation settings 3 48 Chapter 3 Ventilator Operation Operator s manual This page intentionally left blank L2786 AVEA ventilator systems 4 1 Chapter 4 Monitors Displays and Maneuvers Graphic Displays Graphics Colors Graphic displays on AVEA may appear as red blue yellow green or purple tracings These colors may provide useful information to the operator about breath delivery and are consistent between both waveform and loop graphic displays A RED tracing indicates the inspiratory portion of a mandatory breath A YELLOW tracing indicates the inspiratory portion of an assisted or spontaneous breath patient assisted or spontaneous breaths are also denoted with a yellow demand indicator that appears in the left hand
230. tive Leak Percent leakage The difference between the Derived Derived inspired and exhaled tidal volumes in terms of difference Ve Minute Volume Volume of gas exhaled by the 0 to 99 9L Derived patient during the last minute Velkg Minute volume adjusted for patient weight 0 to 999 ml kg Derived Spon Ve Spontaneous minute volume 0 to 99 9L Derived Spon Ve kg Spontaneous minute volume adjusted for patient 0 to 999ml kg Derived RATE TIME MONITORS 3 or 2 bpm whichever is greater Spon Rate Spontaneous breath rate Reflects spontaneous rate for the last minute 0 to 200 bpm 3 or 2 bpm whichever is greater Appendix D Monitor Ranges and Accuracies Operator s manual DISPLAY DESCRIPTION RANGE ACCURACY Ti Inspiratory time 0 00 to 99 99 0 03 sec sec Te Exhalation Time 0 00 to 99 99 0 03 sec sec I E Inspiratory expiratory ratio 1 99 9 to Derived from accuracies for monitored Ti Note Not active for demand breaths 99 9 1 and Te Display Description Range Accuracy fNt Rapid shallow breathing index 0 to 500 Derived from accuracies for spontaneous b24 min L breath rate and spontaneous minute volume DR D O OR Ppeak Peak inspiratory pressure 0 to 120 3 5 of reading or 2 cmH20 Not active with spontaneous breaths cmH20 whichever is greater Pmean Mean airway pressure 0 to 120 3 5 of read
231. to cartridge Figure 2 3 Attaching the Exhalation Filter L2786 2 4 Chapter 2 Unpacking amp Setup Operator s manual Align the locating ridge on the water trap assembly with the slot in the exhalation filter cartridge Figure 2 4 Slot matches locating ridge of water trap assembly Figure 2 4 Exhalation Filter Cartridge Showing Locating Slot Slide the water trap exhalation filter assembly into the cartridge Figure 2 5 Figure 2 5 Exhalation Filter Water Trap Assembly in Cartridge L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 5 Rotate the metal locking lever on the lower right of the ventilator body forward to an open position Figure 2 6 Open locking lever Insert the completed cartridge assembly into the ventilator body as shown Make sure it is completely seated in the well Figure 2 7 Insert exhalation filter Note Placement of the exhalation filter water trap assembly without the exhalation filter cartridge may cause misalignment of the filter seal resulting in patient breathing circuit leaks Close the locking lever Figure 2 8 Close locking lever in place L2786 2 6 Chapter 2 Unpacking amp Setup Operator s manual AVEA Disposable Expiratory Filter Water Trap User Instructions Installation Note The AVEA Disposable Expiratory Filter Water Trap is supplied non sterile I
232. to ensure that the filter is properly installed and securely locked 2 8 Chapter 2 Unpacking amp Setup Operator s manual 4 Drain Tube and Pinch Clamp Inspect for any visible damage and make sure it is securely installed 5 Periodically inspect the filter vial water level and empty it before it reaches the maximum level line 6 To empty the fluid in the collection vial press open the pinch clamp to empty contents of the collection vial into an appropriate receptacle Close and lock the pinch clamp when finished Figure 2 13 Draining water trap WARNING The drain tube must be fully attached to the filter and the pinch clamp must be in the closed position Figure 2 15 Open pinch clamp L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 9 CLEANING Only the exterior of the filter can be cleaned This is done by a gentle wipe down using only mild cleaning solutions that are compatible with polystyrene plastic such as Isopropyl Alcohol or Chlorine Compounds These cleaning solutions are to be diluted by volume in water with a recommended maximum concentration of 1 10 CAUTION Do not attempt to clean the filter media Do not attempt to sterilize or reuse the filter WARNING To avoid increased filter flow resistance do not immerse breathing circuit filters in liquid To avoid a reduction in filtration efficiency do not attempt to scrub
233. ts Pressing the EVENT membrane button to the left of the touch screen opens a scrollable menu of event markers that are placed in the trend buffer along with the 66 monitored parameters To select an event use the data dial to scroll the event menu and highlight the desired event Press the ACCEPT button adjacent to the data dial to place the event in the trend buffer Events will appear on the data spreadsheet in green text with an asterisk next to the time code see Trends below Selectable events include Chest X ray Dx Procedure Feeding Intubation Figure 4 18 The Events menu Event Abbreviation Blood Gas BG Chest X ray CXR Diagnostic Dx Procedure Dx Feeding Feed Intubation ETT Therapeutic Rx Procedure Rx Suction Sxn The following events are automatically recorded in the event log Event Abbreviation Change a primary or advanced control setting Powering the ventilator on Powering the ventilator off Entering Standby exiting Standby Activation of the nebulizer Activation of the expiratory hold Activation of the inspiratory hold A manual breath Activation of the suction button Activation of the increase O2 button Activation of New Patient Involuntary Power Loss amp Recovery Stgs Pon Poff eSby xSby Neb eHold iHold Man Sxn IncO2 NwPt Prec L2786 AVEA ventilator systems Chapter 4 Monitors Displays and Maneuvers 4 25 Trends L2786 The monitored pa
234. ty screen Press the Zero Sensor button under the Hot Wire Flow Sensor section Remove the hot wire flow sensor from the patient circuit Block both ends of the flow sensor with your gloved fingers so no flow occurs L2786 AVEA ventilator systems Chapter 2 Unpacking amp Setup 2 13 co co N gt L2786 While holding the sensor steady without movement press the Continue button Wait for the Zero Sensor Completed message to appear Reinstall the hot wire flow sensor into the patient circuit If the flow sensor continues to drift or read inaccurately repeat this procedure or replace the flow sensor Note The above steps must be executed in the proper sequence If the test is repeated only the last value measured is saved The saved value will then be applied to all future measurements of flow and volume that use this flow sensor This procedure will not fail but is limited on the offset amount it can correct for If the hot wire flow sensor continues to drift or read inaccurately after completing this procedure the offset value is being limited and the sensor should be cleaned or replaced Variable orifice flow sensors are also available on some AVEA models The neonatal VarFlex flow sensor is compatible in neonatal and pediatric applications where the peak inspiratory flow rate is less than 30L min and is not active in adult applications For adult and large pediatric applications a Pediatric Adult VarFlex flow sen
235. ule on the rear of the ventilator 2 Using a small flat blade screwdriver pry open the cover of the power entry module L2786 8 10 Chapter 8 Maintenance and Cleaning Operator s manual 3 Carefully ease the red fuse holder out of the power entry module 4 The fuse holder contains two fuses 3 1 amps for 100 120 volt lines and 2 0 amps for 230 240 volt lines as shown in Table 8 1 5 Replace the failed fuse in the fuse holder with a fuse whose type voltage rating and current rating is identical to the fuses supplied from the factory 6 Carefully replace the red fuse holder into the power entry module Check to ensure that the correct line voltage is uppermost as you re insert the fuse holder into the power entry module L2786 AVEA ventilator systems A 1 Appendix A Contact amp Ordering Information How to Call for Service L2786 To get help on performing any of the preventive maintenance routines or to request service on your ventilator contact Cardinal Health Technical and Clinical Support Hours 6 30 AM to 4 30 PM PST Monday through Friday Phone 800 231 2466 Fax 714 283 8471 After hours service Phone 800 231 2466 from within the US and select option 2 Cardinal Health Customer Care Helpline Hours 24 hours seven days a week Phone 800 231 2466 from within the United States Online service for warrant
236. urate results Note If you do not create an Arterial Blood Gas event no data are stored and no calculations can be performed 2 After analyzing the arterial sample press the Screens button select Maneuvers and then select Capnometry to display the Capnometry Maneuver screen This screen displays data from the last five maneuvers and includes the following e Capnometric data in the digital displays e Capnogram e Date and time of the arterial blood gas event L2786 AVEA ventilator systems Chapter 5 Volumetric Capnography 5 11 L2786 Date and time of the arterial blood gas event Capnographic data Capnogram a a a a tl a MM pacd2 og VA mLAmin Figure 5 9 Capnometry in Maneuver Screen When you exit the maneuver screen the digital displays and waveform return to the original settings Enter PAO2 and or PaCO values using the data dial by touching the appropriate control PAOz input range 0 750 mmHg PaCOz input range 0 250 mmHg Note If you only enter a PCO value Ol and P F ratio will not be calculated Likewise if you only enter a PAOz value the Ol and P F ratio will be the ONLY calculations performed If you do not enter any arterial blood gas values or you failed to create an Arterial Blood Gas event a warning dialog box displays After you enter the arterial blood gas values press Calculate The screen displays the calculated parameters Ensure the arterial bl
237. ure psig Air inlet pressure Air Inlet psig Oxygen inlet pressure Oz Inlet Percentage of oxygen FlO2 ml cmH20 Dynamic compliance Cdyn ml cmH20 Dynamic compliance adjusted for patient weight CdyniKg ml cmH20 Respiratory system compliance Static compliance Cstat ml cmH20 Respiratory system compliance adjusted for patient weight Static compliance CstatiKg C20 C Ratio of the dynamic compliance during the last 20 of inspiration C20 to the total dynamic compliance C FiIVt Rapid Shallow Breathing Index f Vt which is the spontaneous breath rate per tidal volume cmH20 LPS Respiratory system resistance Rrs L min Peak Inspiratory flow rate PIFR L min Peak Expiratory flow rate PEFR Rrs Respiratory System Resistance Rrs is the total resistance during the inspiratory phase of a breath RpeAaKk Peak Expiratory Resistance Rreak is defined as the resistance at the time of the Peak Expiratory Flow PEFR Rime Imposed Resistance Rip is the airway resistance between the wye of the patient circuit and the tracheal sensor Riune Lung Resistance Rung is the ratio of the tracheal pressure differential to the inspiratory flow 12 ms prior to the end of inspiration PIFR The actual peak inspiratory flow rate for the inspiratory phase of a breath PEFR The actual peak expiratory flow rate for the expiratory phase of a breath dPaw Delta Airway Pressure dPaw is the difference between peak airway pressure and baseline airway pressure dPes Delta Esop
238. uses 8 8 respiratory system resistance 4 22 D 2 resume button 3 31 resume current key gt 3 9 S safety information x save loop button 4 5 saving a loop 4 5 scaling histograms 4 25 screen select box 3 30 screens mode selection 3 15 patient select 3 9 patient size 3 10 ventilation setup 3 11 sequence in which the power sources are used 8 6 service calls A 1 Setting Date 2 31 setting the breath type and ventilation mode 3 15 Setting the Language 2 25 Setting the Time 2 31 setting up your AVEA ventilator 2 1 sigh 3 44 7 8 7 12 sigh volume breaths 3 44 SIMV mode 3 22 smart connectors attachment 2 20 smart Heliox connectors 2 20 specifications accessories B 9 atmospheric amp environmental B 8 data input amp output B 3 electrical B 1 physical dimensions B 9 pneumatic B 1 spontaneous breath 3 20 spontaneous breath rate 4 21 D 1 spontaneous minute volume 4 21 D 1 adjusted for patient weight 4 21 D 1 spontaneous tidal volume 4 21 D 1 adjusted for ideal body weight D 1 adjusted for patient weight 4 21 standby mode 3 30 static compliance 4 22 D 2 status indicators 7 1 symbols xii synchronized intermittent mandatory ventilation 3 22 T tidal volume 3 35 time cycled pressure limited breaths 3 18 time high gt 3 33 3 38 control 3 38 time low 3 33 3 39 control 3 39 tracheal catheter 2 17 trended data 4 25 histogr
239. utton selecting Utility and selecting the Monitoring tab L2786 AVEA ventilator systems Chapter 5 Volumetric Capnography 5 13 L2786 Zero CO2 Sensor Figure 5 11 Zero CO2 Sensor message Ensure that CO2 Monitoring is enabled Press Zero CO and press Continue If the sensor is ready to zero a message Zeroing CO Sensor is displayed and a 30 second countdown timer starts Note If the message CO2 Sensor not ready to zero is displayed after pressing Continue a 120 second countdown time starts The sensor will not be ready to zero if it is not up to its operating temperature if it detects breaths or if there is a sensor malfunction When the sensor becomes ready to zero Zeroing CO2 Sensor is displayed and a 30 second countdown timer will start When the sensor is zeroed Zero CO2 PASS is displayed When the CO sensor sends a Zero Failed message the timer stops and a message Zero CO FAIL appears When the countdown timer reaches zero without the CO2 sensor returning a Zero pass or fail the message Zero CO2 TIMEOUT displays Note that in this event the actual operation of zeroing the sensor may subsequently continue to completion If this should occur before activation of the Exit control the message is replaced by Zero CO2 PASS or Zero CO FAIL as appropriate Press Exit to close the message It is possible to close the CO Zero Popup while the zero procedure is in prog
240. ve Humidity non condensing Capnometry Airway Adapters Reusable Adapters Clean reusable adapters by rinsing them in warm soapy water followed by soaking them in a liquid disinfectant such as 70 isopropyl alcohol 10 bleach solution 2 4 glutaraldehyde solution such as Cidex Steris System1 or ammonia Rinse with sterile water and dry before use L2786 AVEA ventilator systems Chapter 8 Maintenance and Cleaning 8 3 The adapter may also be disinfected using one of the following methods Steam autoclave the adapter adult adapter only Immerse and soak the adapter in 2 4 glutaraldehyde solution such as Cidex for 10 hours Immerse and soak the adapter in 0 26 paracetic acid solution such as Perasafe for 10 minutes Use Cidex OPA follow manufacturer s instructions for use Before reusing the adapter ensure the windows are dry and free of residue and that the adapter has not been damaged during the cleaning disinfecting process Disposable Adapters Treat all single patient use adapters in accordance with institutional protocol for single patient use items Additional Information The following are considered disposable parts and therefore Cardinal Health does not recommend a method of cleaning or sterilization L2786 Disposable Variable Orifice Flow Sensors PN 50000 40038 and PN 50000 40031 Tracheal Adapters PN 50000 40034 Tracheal Catheters PN 10635 Catheter Extention Tubes PN 50000 09910 and PN
241. wall outlet Verify that the Loss of AC alarm activates Reconnect the AC power cord Clear the alarm by pressing the reset button Occlude the exhalation exhaust port Verify that the High Ppeak alarm activates followed 5 seconds later by the activation of the Ext High Peak Alarm Set the control setting for rate to 1 bpm Verify that Apnea Interval alarm activates after the default setting of 20 seconds Return the control setting to its default value and clear the alarm by pressing the reset button Set the Low PEEP alarm setting to a value above the default control setting for PEEP on your ventilator Verify that the Low PEEP alarm activates Return the alarm setting to its default value and clear the alarm by pressing the reset button Set the High Ppeak alarm setting to a value below the measured peak pressure or in neonatal ventilation the default control setting for Inspiratory Pressure on your ventilator Verify that the High Ppeak alarm activates Return the alarm setting to its default value and clear the alarm by pressing the reset button Set the Low Ve alarm setting to a value above the measured Ve on your ventilator Verify that the Low Ve alarm activates Return the alarm setting to its default value and clear the alarm by pressing the reset button Set the High Ve alarm setting to a value below the measured Ve on your ventilator Verify that the High Ve alarm activates Return the alarm setting to its defaul
242. when the patient initiates a breath Paw star Requires an esophageal balloon 0 to 50 cmH20 2 cm H20 or 5 whichever is greater Ptp Plat Transpulmonary pressure during an inspiratory hold which is the difference between the airway plateau pressure PpLat aw and the corresponding esophageal pressure Requires an inspiratory hold and esophageal balloon 60 to 120 cmH20 2 cm H20 or 5 whichever is greater D 4 Appendix D Monitor Ranges and Accuracies Operator s manual Ptp PEEP The difference between the corresponding airway 60 to 120 2 cmH20 or 5 whichever is greater and esophageal pressures at the end of the cmH20 expiratory hold during an AutoPEEP maneuver Requires an inspiratory hold and esophageal catheter MIP The maximum negative airway pressure that is 60 to 120 2 cmH20 or 5 whichever is greater achieved by the patient during an expiratory hold cmH20 maneuver P100 The negative pressure that occurs 100 ms after an 60 to 120 2 cmH20 or 5 whichever is greater inspiratory effort has been detected cmH20 L2786 AVEA ventilator systems Appendix D Monitor Ranges and Accuracies D 5 L2786 Display Description Range Accuracy WOBy The summation of airway pressure Paw minus the 0 00 to 20 00 10 baseline airway pressure PEEPaw times the Joules L change in tidal volume to the pati
243. with line feed Indicates ACCEPT entered values for a specific field S Cardinal Health Symbol Indicates PATIENT EFFORT h g Cardinal Health Respiratory Care symbol Indicates MANUAL BREATH L2786 AVEA ventilator systems xiii L2786 Cardinal Health Symbol MAIN SCREEN HN Symbol 417 IEC 5102 EVENT READY J Cardinal Health Symbol MODE C Cardinal Health Symbol ADVANCED SETTINGS Cardinal Health Symbol SET UP for patient size selection MDD Directive 93 42 EEC CE Mark Symbol 5307 IEC 60417 ALARM RESET Symbol 5319 IEC 60417 ALARM SILENCE Cardinal Health symbol ADULT patient Cardinal Health symbol PEDIATRIC patient Cardinal Health symbol NEONATAL Infant patient Graphical Symbol in general use internationally for DO NOT CANCEL i e do not accept entered values Cardinal Health symbol Select DISPLAYED SCREEN function Symbol 5467 IEC 60417 FREEZE the current display xiv Operator s manual Cardinal Health symbol Enable the ALARM LIMITS screen Cardinal Health symbol This symbol indicates a CONTROL LOCK Cardinal Health symbol NEBULIZER port of Cardinal Health symbol Increase OXYGEN Ss Cardinal Health symbol PRINT SCREEN Cardinal Health symbol SUCTION port Cardinal Health symbol VARIABLE ORIFICE FLOW SENSOR connection
244. xpected transport time be delayed beyond this a dedicated transport system should be considered As with any patient transport suitable manual ventilation backup should be available CAUTION Prior to operating on battery power the internal and external if connected battery indicator s should be green The ventilator should be connected to a mains AC power supply until the battery indicator s show green prior to operating on battery power An optional sealed lead acid SLA external battery pack is also available This can significantly extend the operating period of the ventilator when it is not connected to an AC source Under normal operating conditions fully charged 8 6 Chapter 8 Maintenance and Cleaning Operator s manual external and internal batteries combined are capable of powering the ventilator and compressor for a period equal to or greater than 2 hours and the ventilator on wall air for a period equal to or greater than 4 hours Both battery types are re chargeable and require some maintenance when installed The internal battery should be discharged and recharged approximately once every three months The external battery should be discharged and recharged approximately once every twelve months The Battery Status Indicators on the front panel enable you to monitor the battery charge remaining see Chapter 7 Alarms and Indicators CAUTION Should your internal battery require replacement con
245. y left blank L2786 AVEA ventilator systems l 1 Appendix Volumetric CO2 Calculations L2786 Note The AVEA assumes all gas passing through the sensor to be at BTPS except during calibration check Barometric pressure PBar is measured with an integrated barometric pressure sensor Gas composition must be known by the CO sensor and algorithms to ensure accurate reporting of PCO2 The AVEA internally reports delivered gas composition data PCO Partial pressure of carbon dioxide in the inhaled and exhaled gas measured continuously and reported by the CO sensor at the wye This is displayed graphically as the capnogram waveform EtCO Peak partial pressure of carbon dioxide in exhaled gas reported by the CO sensor at the wye This is calculated for each breath and then averaged as specified by setup control EtCO Averaging FCO Fraction of carbon dioxide in the inhaled and exhaled gas measured continuously and reported by the CO sensor at the wye This value is used in the VcO2 and dead space calculations but is not displayed FCO PCO P PEEP VCO Minute volume of exhaled CO It is measured continuously and averaged over a user selectable time VCO2 Average 3 6 9 12 minutes VCO Pie FCO ar t i lmin wye is the flow at the wye and is measured or calculated VtCO Tidal volume of exhaled CO3 It is measured over the period of each breath and averaged over a user
246. y replacements parts can be found at cardinalhealth com bird Select Warranty Form from the choices on the left of the screen A 2 Appendix A Contact amp Ordering Information Operator s manual Ordering Parts To obtain AVEA Ventilator parts contact Cardinal Health customer service at Hours 7 00 Am to 4 30 PM PST Monday through Friday Phone 800 328 4139 760 778 7200 Fax 760 778 7274 Accessories Neonatal Kit Part Number 50 40012 00 Cardinal Health Part Description Quantity Number 50000 40038 Neonatal disposable flow sensor 1 External Battery Option To add the external battery option to your AVEA you will need to order the following parts Cardinal Health Part Description Quantity Number 33977 External Battery Tray Assembly 1 16217 External Battery Wire Harness 1 68269 AVEA External Battery 2 Other Replacement Parts and Accessories Cardinal Health Part Description Number 71667 Internal External Battery Fuse 71612 100 120 VAC Mains Power Supply Fuse 56000 20064 230 240 VAC Mains Power Supply Fuse 33978 Gas Tank Rack Assembly 51000 40640 Filter Cartridge 11590 Disposable Expiratory Filter Water Trap case of 12 11556 Disposable Water Trap case of 12 L2786 AVEA ventilator systems Appendix A Contact amp Ordering Information A 3 Advanced Physiologic Monitoring Parts and Accessories Pkgs of 10

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