NITRONOX USER'S MANUAL / INSTRUCTIONS
Contents
1. E Stand 1 Two cylinders of Op and two cylinders of N O are typically connected at all times Exception When using external gas supply of oxygen the E Stand may be populated with N O cylinders and O cylinders are not placed on E Stand 2 Minimize leak risks Confirm Yoke Washers are in place before replacing mounting cylinders Use Porter A 3399 000 replacement washers once yr Have spare washers 11 10 11 12 Minimize leak risks With cylinder in position rotate swivel arm and move into secure locked position when Tee Handle is tightened To prevent movement and potential damage to yoke pins always fasten the Hook amp Loop strap restraints around cylinders Assure E Stand is populated with at least one full cylinder of O2 and N O before starting any procedure Label each cylinder with a tag or sticker indicating In Use and Full Full is reserve cylinder Use Cylinder Valve Wrench to open the In Use cylinders of O and N O Verify wrench is attached to Block Cylinder pressure gages on Block provide a visual indication of cylinder status see details on Cylinder Pressure Readings Caution If all four cylinders or both cylinders of one gas are open the two cylinders of O and NO will deplete in tandem The Full cylinder will empty with the In Use cylinder and will not be available as a future spare When In Use cylinder is depleted2. This warranty shall be void on any product on which the serial number has been altered defaced or removed ORDERS All orders are to be made through authorized Parker Hannifin Corporation distributors All billing will be done through said distributors Direct orders will be handled through the authorized local dealer as determined by Parker Hannifin Corporation RETURNS All returned merchandise will be handled through the local Parker Hannifin Corporation distributor No returns will be accepted unless authorized in writing by Parker Hannifin Corporation and accompanied by the original shipping invoice All returns are subject to restocking charge Policies subject to change without notice The Quality System for Porter Instrument is certified to ISO 13485 The scope of Our registration is The design manufacture distribution and servicing of Nitrous Oxide Oxygen Sedation Flow Meters Gas Scavenging Systems Steam Sterilizers Gas Distribution and Office Communication Systems for use by a physician dentist or licensed healthcare professional
3. open the spare Full cylinder Close valve on empty cylinder When In Use Os cylinder is depleted the Oxygen Fail Safe will stop NO flow and demand valve flow automatically When In Use N O cylinder is depleted the Nitronox will deliver 100 Os through the Demand Valve After use turn off cylinder valves Caution With Os cylinder turned on the Nitronox will have an intentional small O bleed which will tend to deplete the Os cylinder if after use the O cylinder valve is left on Models With EI Cylinder Yoke Simple Operation Procedure 1 Open one each O and N20 Cylinder Valves with wrench provided 2 Observe cylinder pressures Replace cylinder Fig 23 1 when less than 300 psi at room temperature 21 1 C 70 F During replacement close all Cylinder Valves 3 Observe line pressures Fig 23 1 Normal is 50 55 psi green band for static no flow condition Pressure will decrease slightly during each inspiration see Maintenance 4 Observe mixture pressure Fig 23 2 Normal is 30 35 psi green band for static no flow condition Pressure will decrease slightly during each inspiration see Maintenance 5 If all pressures are normal Nitronox is ready to use Remove Demand Valve with Mask from storage bracket Instruct patient to hold Mask lightly on face covering nose and mouth Instruct to breathe normally preferably through nose Fig 23 2 Encourage patient to se
4. effective in achieving low levels of ppm parts per million exposure Contact Porter or Authorized Distributor for details on monitors and testing Inspect and maintain the analgesia delivery system to prevent N2O leaks in all hoses connections and fittings Have all leaks repaired immediately WARNING Medical workers are exposed to N20 during administration of N20 O2 conscious sedation analgesia NIOSH has recommended that exposures should be minimized Contact NIOSH 1 800 35 NIOSH to receive NIOSH Publications on Control of Nitrous Oxide in Dental Operatories Exposure can be minimized by effective controls National Institute for Occupational Safety and Health NIOSH publications state that controls including System Maintenance Ventilation and Work Practices can effectively reduce N O concentrations in patient procedures Your accessory Porter scavenger system is an important part of the system of controls in medical settings CAUTION Always use clean dry medical grade gases Introduction of moisture or other contaminants into this device may result in defective operation CAUTION Do not attempt to repair alter or calibrate this device Unauthorized repair alteration or misuse of this device is likely to adversely affect the performance and will void the warranty CAUTION Never oil or grease any part of this system minimize fire or explosion potential WARNING N NEW OR MODIFIED INSTALLATIONS ALWAYS ASSU
5. NING Oxygen input pressure more than 15 psi higher than Nitrous Oxide input pressure will cause low oxygen percentage mixture delivery DO NOT use Nitronox if O2 input exceeds N2O input by 15 psi or higher SELF ADMINISTRATION VS ASSIST TO SELF ADMINISTRATION WARNING Encourage patient to self administer Self administration is a safety feature of the demand flow Nitronox in that if for any reason the patient becomes over sedated the patient will be unable to successfully hold the mask in a tight seal position on the face The result will be that the mask falls away from the face and the demand flow will cease allowing the patient to breathe room air in through the mouth or nose WARNING If a patient is unable to fully self administer and the medical professional provides an assist to placement of the mask in a sealing position on the face maintain patient observation to prevent over sedation under any conditions Discontinue the assistance in mask placement immediately upon any observation of over sedation remove the mask from the face entirely Never use a mask strap to hold the mask to the face Never force the mask on the face the patient must always be spontaneously breathing As an added precaution for procedures where an assist to self administration is used continuously sample the mixture delivery downstream from the demand valve by installation of an oxygen analyzer Section 1 Installations Nitronox Main Housing Mobile E St
6. Parker Hannifin Corporation Porter Instrument Division 245 Township Line Rd Porter Hatfield PA 19440 USA 215 723 4000 fax 215 723 5106 NITRONOX USER S MANUAL INSTRUCTIONS 10115900 Rev L 02 13 www porterinstrument com nitronox Nitronox Hospital Model Inhalation Analgesia Machine Serial Number Table of Contents Sun He Ee een 1 VVarninds nd FEM ae a 2 New or Modified Installations nenne nenne nenn ia 3 Self Administration vs Assist to Self Administration nenn 3 Installations Preparation of Mobile E Stand nen 4 Installations Preparation of Nitronox Scavenger Parts c ccccccsecesseeeseeeeeseeeees 6 Installations Attachment of Cylinders en nennen nnnnn nennen 7 POS 0 0 0 E 8 FUNCIONAN SCMEIMAUC usa 9 Specilications Functional EE 10 FUNGIGNal Warnings and GAUlONS E 10 Functional Tests naar 10 Operation 7 Maintenance 11 ITOUDIESNOOUNG E 14 EEN ee Ee ei 15 Examination Examine shipping carton for signs of external damage Remove contents from carton and inspect for visible damage or missing parts If damage is discovered or suspected and or parts are missing notify Porter or authorized distributor immediately IMPORTANT READ MANUAL COMPLETELY BEFORE OPERATING THIS DEVICE Basic delivery technique is described Also this manual contains instructions on periodically required checks to be performed by the user These checks are necessary to insure the proper performance of this device a
7. RE THAT LINES ARE NOT CROSSED WARNING New or modified central supply installations properly connected gas pipelines are absolutely essential to patient safety The authorized distributor or contractor should provide written documentation that all gas pipelines are connected properly and that the system has been pressure tested prior to use While this is a good business practice it is important that the user verify by their own test independent of the authorized distributor or contractor that all gas pipelines are connected correctly prior to using the system The ultimate responsibility of assuring that lines are not crossed rests with the user Do not allow crossed lines to defeat the safety features of the Nitronox and or central gas supply manifold systems Crossed lines will create a dangerous and hazardous condition where under a loss of oxygen supply 100 nitrous oxide will be delivered through the oxygen delivery path and subsequently to the patient Maintain patient observation during procedures Prevent over sedation If a patient becomes over sedated when being delivered 100 oxygen during an apparent loss of nitrous oxide supply it is a definite indication of crossed lines If crossed lines are suspected remove the mask immediately and encourage mouth breathing Deliver pure oxygen from an oxygen demand valve only if the oxygen source is independent from the suspected crossed lines area INPUT PRESSURE DIFFERENCES WAR
8. Supply Wal Cyl Press Gauge Nal Line Press Gauge Nol External Gas Supply 40 65 P l Oxygen Da Mixture Press Control Cylinder Supply Adjust Screw with Lock Nui NU GA Valve X Og Cyl Valve gt Oo Cyl I Press Gauge ETT NoO Cyl Press TT Do Cyl Regulator 30 55 P l Press Regulator 50 55 PSI Os Line Press Gauge Eo Check Valve EO Check VM Check Valve Valve Q 0 External Gas Supply 40 65 P l Mixture ES 1C d D Not Preset Prasat Orifice Mixture Orifice Press Gauge 30 35 PSI Whistle z e SE Demand Valve With Exhalation Valve To Face Mask and Patient Alarm Actuator Section 3 Specifications Functional Features Gas Supply Duration E Size Cylinders At Normal Breathing Rates N O Approximately 6 6 5 Hrs Flow Capability 114 LPM Maximum Mixture Concentration Mixture Concentration Factory Adjusted 50 N O and 50 O O Approximately 2 2 5 Hrs Oxygen Fail Safe If apparatus oxygen line pressure is depleted or disconnected nitrous oxide flow and demand valve flow stops automatically If apparatus nitrous oxide line pressure is depleted or disconnected demand valve will continue to function providing 100 oxygen at reduced flow capacity of about 55 LPM If patient takes abnormal shallow breaths 100 to 200 cc tidal volume oxygen concentration automatically increases Mixer P
9. alve flow must stop completely Section 4 Operation Maintenance Cylinder Pressure Readings Oxygen is a true compressed gas while in the cylinder thus the cylinder pressure gauge can be used to determine the amount of gas remaining in the cylinder For example 2000 psi indicates full 1000 psi indicates half full etc Nitrous Oxide is a liquefied compressed gas that vaporizes in the cylinder thus the cylinder pressure gauge cannot be used to determine the amount of gas remaining in the cylinder until all liquid in the cylinder vaporizes While liquid remains in the cylinder the cylinder pressure gauge indicates the vapor pressure which depends on and varies with the temperature of the liquid For example at 68 F the vapor pressure is about 750 psi at 20 F it drops to about 400 psi while at 90 F it increases to about 1000 psi After all the liquid vaporizes the pressure will decrease normally as the gas is withdrawn and the cylinder pressure gauge can then be used to determine the amount of gas remaining in the cylinder Cautions e Always turn on CYLINDER VALVES slowly and fully E cylinder yoke models e Hex hole in cylinder valve wrench to be used only to tighten cylinder valve packing nut in event of a leak e NEVER ATTEMPT TO LOOSEN cylinder valve packing nut If valve stem is tight return cylinder to supplier Warning Do not remove or alter gas indexing pins Good practices Cylinders with
10. and Fig 1 1 Mobile Stand Wall Mount Fig 1 2 Demand Valve Corrugated Hose Scavenger Interface Preparation of Mobile E Stand Fig 1 1 Also see FM 916 E Stand User s Instructions 1 Slide Center Column with Cylinder Restraint and Cylinder Yoke Block into 5 Star Base Fig 2 1 Push down firmly until snug Align Cylinder Restraint as shown Base of cylinders will fit in between wheels Fig 2 2 Fig 2 1 u Fig 2 2 Adjust the Recessed Mounting Post to highest height by loosening and tightening the small black handle Fig 3 1 on the Yoke Block and raising the Mounting Post Fig 3 2 The Nitronox Main Housing will mount on the Mounting Post of the E Stand or Mobile Stand by sitting the bottom of the Housing Fig 4 1 on top of the Mounting Post larger threads Fig 4 2 Hold the Mounting Post in one hand and position the Housing with the other Secure the Housing on the Mounting Post Fig 5 1 by twisting the Post counterclockwise with one hand and holding the Housing steady with the other hand Twist until the Post is snug Fig 5 2 Fig 1 1 Wall Mount Fig 5 1 Preparation of Mobile E Stand continued 5 Attach the Handle Fig 6 1 to the Mounting Post just under the Retaining Ring O ring Fig 6 2 Firmly tighten both screws so that the Handle cannot be twisted The back of the Handle should be positioned over the back two cylinders Fig 6 3 6 Caref
11. breathing supply N20 cylinder contains up to 6 5 hrs Apparatus exposed to temperature below 32 F 0 C PRESSURE REGULATOR out of adjustment models with E cylinder yoke PRESSURE REGULATOR defective models with E cylinder yoke CONTROLLED PRESSURE REGULATOR section of mixture requires adjustment REGULATOR malfunction models with E cylinder oke ALARM ACTUATOR out of adjustment ACTUATOR DEFECTIVE Leak at N20 pressure control seat causing low O2 concentration ACTUATOR DEFECTIVE 14 CORRECTIVE ACTION Replace with Porter part No A 3399 000 4 per Unit Replace cylinder with full cylinder of appropriate gas Use practice of turning off cylinder or external supply after use Expect higher usage of O2 cylinders Allow apparatus to return to room temperature before making adjustment See Maintenance adjustment Step 1 Discontinue use and notify authorized distributor See Maintenance adjustment Step 2 Discontinue use and notify authorized distributor See Maintenance adjustment Step 3 Discontinue use and notify authorized distributor Discontinue use and notify authorized distributor CERTIFICATE OF WARRANTY THIS WARRANTY IS GIVEN IN PLACE OF ALL OTHER WARRANTIES EXPRESS OR IMPLIED OF MERCHANTABILITY FITNESS FOR A PARTICULAR PURPOSE OR OTHERWISE Under no circumstances shall Parker Hannifin Corporation be liable for in
12. cidental or consequential damages as those terms are defined in the uniform commercial code Parker Hannifin Corporation Porter Instrument Division warrants that each product or part shall be free from defects in workmanship and materials under normal use and with appropriate maintenance for one 1 year from the date of delivery to customer unless otherwise specified in writing All rubber and plastic parts and accessories are warranted under the same conditions for a period of ninety 90 days from date of purchase No statement or claim about the product by any employee agent representative or dealer of Parker Hannifin Corporation shall constitute a warranty by Parker Hannifin Corporation or give to rise to any liability or obligation of Parker Hannifin Corporation Parker Hannifin Corporation shall not be liable for any damage injury or loss arising out of the use of the product whether as a result of a defect in the product or otherwise if prior to such damage injury or loss the product was 1 damaged or misused 2 repaired altered or modified by persons other than Parker Hannifin Corporation 3 not installed in strict compliance with applicable codes and ordinances or 4 not installed by an authorized Parker Hannifin Corporation dealer Parker Hannifin Corporation s obligation for breach of this warranty or for negligence or otherwise shall be strictly and exclusively limited to the repair or replacement of the product or part
13. ench hanging from black Knob is used to open close Cylinder Valves Fig 19 See FM 916 User s Instructions N O Pins Rubber Fig 16 1 9 ne aner Section 2 Description of Unit The Nitronox Hospital Model is an inhalation analgesia apparatus designed to deliver a fixed concentration of 50 nitrous oxide and 50 oxygen on the demand flow principle Nitronox operates either on pipeline gas supply using a Mobile Stand or Wall Mount or medical E or D size cylinder supply by means of a small cylinder yoke block with regulators Mobile E Stand The Nitronox Hospital Model is available in various configurations offering three mounting styles 1 Nitronox Hospital with Mobile Stand only for use with pipeline gas supply only 2 Nitronox Hospital with Mobile E Stand Fig 20 and cylinder mount 2 nitrous oxide and 2 oxygen E or D size Refer to FM 916 for Installation and User Instructions 3 Nitronox Hospital with wall mount for use with pipeline gas supply Use Nitronox Hospital Model in conjunction with Nitronox Scavenger System Refer to User s Manual Instructions 10152100 Fig 20 Fig 20 Nitronox Hospital Model with Mobile E Stand Fig 21 Nitronox Front Cover with Mixture Pressure and N O and O Line Pressure Gages Nitronox Hospital Model Inhalation Analgesia Machine FUNCTIONAL SCHEMATIC Nitrous Oxide N70 Cylinder
14. heck of working pressure leaks Verify hoses are attached from E Stand to Nitronox Housing Turn one O and one N20 cylinder on Verify E Stand pressure gages read cylinder pressures Verify Nitronox line pressure gages read within green band Note fail safe is open and pressure reaches Demand Valve Turn off N O cylinder valve Verify that N20 E Stand gage reads about 750 psi Note exact needle position Verify that there is little or no movement up to 1 2 increment of the exact needle position in 15 minutes Nitronox N O line pressure gage needle will stay in green band with no movement Turn off Os cylinder valve It is normal that needle of O E Stand gage will drop Nitronox O line pressure gage needle will stay in green band with no movement will eventually drop after E Stand gage pressure naturally depletes 9 Whistle Alarm Actuator Adjustment Remove UPPER CHROME PLUG from case back With mixture pressure temporarily adjusted in middle of range shown below per Step 2 Maintenance insert 1 8 hex key not provided into adjustment screw at end of ALARM ACTUATOR see illustration Fig 2 Adjust screw either clockwise or counterclockwise until whistle sounds clearly DO NOT over adjust Return mixture pressure to middle of green band Whistle sound must stop with pressure in green band and whistle must sound with pressure in range shown below about 40 psi If this cannot be achieved discontinue use of apparat
15. lf administer at all times see Warnings page 3 for details 6 After use turn off Cylinder Valves store Demand Valve with Mask and Hose Models Using Pipeline or External Gas Supply Mobile Stand or Wall Mt 1 Connect external gas supply hoses to DISS Diameter Indexed Safety System fittings External pressure must be 40 65 psi preferably 50 55 psi Observe external pressures on apparatus LINE PRESSURE GAUGES WARNING DO NOT use Nitronox if O2 input exceeds N2O input by 15 psi or higher 2 Observe mixture pressure as in step 4 above 3 Follow step 5 procedure above 4 After use disconnect external gas supply 12 Maintenance 1 Line Pressure Adjustment Green Band for Model Using Mobile E Stand Locate appropriate PRESSURE REGULATOR blue lettering nitrous oxide green lettering oxygen remove 9 16 acorn nut insert 5 32 hex socket key and adjust pressure to within green band Mixture Pressure Control Adjustment Green Band Remove LOWER CHROME PLUG from case back With wrench loosen 7 16 inch hex nut counterclockwise approximately one quarter turn Insert screwdriver through access hole in bottom of case into slot of adjusting screw While holding nut with wrench adjust counterclockwise to increase pressure clockwise to decrease After adjustment tighten nut while holding screw in position with screwdriver see illustration Fig 24 Leak Test System Monthly C
16. nd its safety features Retain this manual for future reference N WARNINGS AND PRECAUTIONS These warnings and precautions are to help you to understand how to safely operate the Nitronox device A WARNING alerts you to a possible hazard to people A CAUTION alerts you to the possibility of equipment damage WARNING New or modified installations properly connected gas pipelines are absolutely essential to patient safety The ultimate responsibility of assuring that lines are not crossed rests with the user See next page for details WARNING Porter Instrument equipment utilizes the cross protection system The flexible hose and connectors that connect to the housing are diameter indexed 3 8 O D for Nitrous Oxide and Le O D for Oxygen The cross protection system is designed to prevent misconnection of Oxygen and Nitrous Oxide hoses DO NOT ATTEMPT TO CHANGE THE DIAMETERS OR CONNECTORS OF THE DEVICE Tampering with the cross protection system constitutes acceptance of liability by the installer WARNING Nitronox Analgesia units are intended to be used by medical personnel trained in its use and the use of nitrous oxide and oxygen for medical applications WARNING Do not use this device for the administration of general anesthesia or as a part of or in conjunction with a general anesthesia administration system WARNING Use Scavenging Monitor for N2O in the patient treatment area to insure that controls are
17. nders Caution When operating the swivel yoke take care not to catch or pinch fingers 12 Loosen the Tee Handle Fig 14 1 until point is even with the inside of the Swivel Arm Push Tee Handle inwards to flip to Fig 16 4 O Pins open position Align Tee Handle vertically Fig 16 3 Fig 14 2 ege Warning Do not remove or alter gas indexing pins 16 Slide the cylinder into place by lining up the pins and pin holes on the cylinder Push into place Properly placed the cylinder should hang on the pins Fig 17 17 Cylinders should hang freely between wheel base Ifthe wheel base interferes 13 Undo the Hook amp Loop straps on the loosen and rotate cylinder restraint Cylinder Restraint Fig 15 18 Rotate swivel clockwise to close Fig 18 1 Swivel will move into the locked position when Tee Handle is tightened Secure the Fia 15 Hook amp Loop straps to hold cylinder in g place Fig 18 2 14 Cylinder Preparation Remove any plastic wrap from the top of cylinder including the cylinder plastic washer Verify that the rubber washer Fig 16 2 provided with the E Stand is still in place Use the E Stand washer 15 Mount the E cylinders of Oxygen and Nitrous Oxide not included to the E Stand Block Insert cylinders correctly on indexing pins and as marked on Block N20 Figs 16 1 16 2 Oo Figs 16 3 16 4 Pins assure mounting in appropriate position 19 The Cylinder Valve Wr
18. ressure Alarm A whistle will sound when a gas mixture regulator seat malfunction affecting mixture concentration has occurred Warning Nitronox Analgesia units are intended to be used by medical personnel trained in its use and the use of nitrous oxide and oxygen for medical applications A Warnings e DO NOT use Nitronox if either line or mixture pressure is out of green band see Maintenance Figs 22 1 22 2 Fig 22 1 Fig 22 2 e Encourage patient to self administer at all times see Warnings page 3 for details 5 Percentage Points O AN Warnings e If WHISTLE ALARM sounds discontinue patient use immediately and shut off gas supply e WARNING DO NOT use Nitronox if O2 input exceeds N2O input by 15 psi or higher see Warnings page 3 Functional Tests Prior to first use and periodically thereafter monthly is suggested perform the following tests Whistle Alarm Actuation 1 Increase mixture pressure per Page 7 Step 2 Maintenance until gauge reading is in RED Do Not Use area per gauge illustration WHISTLE should sound in this range If WHISTLE sounds before or after this range WHISTLE ALARM ACTUATOR must be adjusted see Maintenance Fail Safe Check Out Test 1 With unit in operation one each O2 amp N2O gas supplies on turn off or disconnect oxygen at supply source 2 As oxygen pressure falls to zero as read on oxygen line pressure gauge demand v
19. ully clip the shipping accessory plastic fasteners off of the green Oxygen Hose and blue Nitrous Oxide Hose under the E Stand Block Fig 7 Be careful do not cut the Hoses Fig 7 Connect the Diameter Indexed Safety System DISS green Oxygen and blue Nitrous Oxide Hoses to the appropriate connections Fig 8 1 on the bottom of the Nitronox Main Housing Slide the Hoses through the opening in the Handle Fig 8 2 before connecting Firmly tighten the Hoses using a wrench Fig 8 1 Fig 8 2 10 Follow instructions FM 1236 included with Preparation of Nitronox Scavenger Parts 19mm Magenta Hose Part number 92120041 19mm Corrugated Scavenger For further details refer to Nitronox Scavenger Hose Assembly Instructions Figs 11 1 User s Manual 10152100 11 2 Fig 12 8 Connect the Demand Valve Fig 9 1 to the black Gas Delivery Hose connected through underside of Nitronox Main Housing Fig 9 2 This is a quick connect attachment Push the two ends together until click sound is heard Fig 9 3 To remove push the metal clip in and pull apart Fig 11 1 Fig 11 2 Fig 12 Fig 9 3 9 The bracket and clip on the side of the Nitronox Scavenger on Housing Housing Fig 10 1 may be used to hold the Demand Valve assembly and Hoses 11 Attach the Nitronox Scavenger Interface to when not in use Fig 10 2 the Center Column Figs 13 1 13 2 Fig 10 1 Fig 10 2 Attachment of Cyli
20. us and notify authorized distributor immediately see illustration Fig 25 Replacing the Check Valve See FM 916 E Stand for illustrations and instructions for replacement of the Check Valve Assembly Wrench Adjust Screw Lock Nut 7 16 Hex Mixture Pressure Control Adjustment screw Screwdriver Fig 24 Whistle Sound Range P rear Band __ Mixture Pressure Gauge Back ol Lage Fig 25 Section 5 Troubleshooting IN Field repair is limited to maintenance adjustments and replacement parts obtained through Porter All other repairs should be performed by an authorized Porter service representative PROBLEM Leakage at YOKE CYLINDER VALVE connection Low or no reading on CYLINDER GAUGE with CYLINDER VALVES open O cylinder or external supply used too quickly Line pressure out of green band Mixture pressures out of green band WHISTLE ALARM failure during functional test 7 WHISTLE ALARM sound Note a momentary chirp sound is acceptable upon initial application of pressure if whistle then stops reseats POSSIBLE CAUSE Missing or defective yoke seal washer models with E cylinder yoke damaged pins Cylinder pressure too low or cylinders empty models with E cylinder yoke O2 cylinder valve or external supply left on after use and natural bleed depletes cylinder or external supply O2 cylinder contains up to 2 5 hrs
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