Puritan Bennett 520 ventilator Clinician's Manual
Below you will find brief information for ventilator 520. The Puritan Bennett 520 ventilator is a portable, lightweight, and easy-to-use device. It features a variety of ventilation modes, including Assist/Control (A/C), CPAP, and PSV. The ventilator also includes a number of safety features, such as alarms for high and low pressure, low battery, and disconnection.
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Clinician’s Manual Puritan Bennett TM 520 Ventilator Copyright information COVIDIEN, COVIDIEN with logo, the Covidien logo and positive results for life are U.S. and/or internationally registered trademarks of Covidien AG. All other brands are trademarks of a Covidien company. © 2012 Covidien. The information contained in this manual is the sole property of Covidien and may not be duplicated without permission. This manual may be revised or replaced by Covidien at any time and without notice. You should ensure that you have the most current applicable version of this manual; if in doubt, contact Covidien's Technical Support department or visit the Puritan Bennett product manual web page at: http://www.respiratorysolutions.covidien.com While the information set forth herein is believed to be accurate, it is not a substitute for the exercise of professional judgment. The ventilator should be operated and serviced only by trained professionals. Covidien’s sole responsibility with respect to the ventilator, and its use, is as stated in the limited warranty provided. Nothing in this manual shall limit or restrict in any way Covidien’s right to revise or otherwise change or modify the equipment (including its software) described herein, without notice. In the absence of an express, written agreement to the contrary, Covidien has no obligation to furnish any such revisions, changes, or modifications to the owner or user of the equipment (including its software) described herein. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Purpose of This Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Qualification of Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Technical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 1 2 1 Safety Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.2 1.3 1.4 1–1 Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–1 Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–1 Symbols and Markings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–11 Labels / Identification and Instruction Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–14 2 Ventilator Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Operational Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Device Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Front Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Back Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . USB Memory Device Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If Ventilator Failure Occurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2–1 2–1 2–2 2–2 2–3 2–4 2–5 2–6 2–7 2–8 2–9 2–9 3 Operating Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 3.2 3.3 3.4 3–1 PSV Mode Parameters and Setting Ranges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–1 CPAP Mode Parameters and Setting Ranges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–6 P A/C Mode Parameters and Setting Ranges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–8 FiO2 For Various Oxygen and Ventilator Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–13 4 Monitored Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 4.2 4.3 Digital Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bargraph Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Alarms and Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 5.2 5.3 Clincian’s Manual Alarm Level of Priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Log Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–1 4–1 4–4 4–4 5–1 5–1 5–2 5–3 i Contents 5.4 5.5 5.6 5.7 5.8 Silencing the Audible Portion of Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–4 Pausing/Resetting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–5 Re-activating Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–6 Overview of Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–7 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–14 5.8.1 Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–14 5.8.2 Additional Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–21 6 Installation and Assembly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 6.2 6.3 6.4 Installing the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Connecting to External AC Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Connecting to an External DC Power Source. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4.1 Choosing the Patient Circuit Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4.2 Installing the Patient Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6 Humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7.1 Administering Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7.2 Connecting the Oxygen Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 Fitting the Ventilator into the Dual Bag. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 Mounting the Ventilator on a Wheelchair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.10 Mounting the Ventilator on the Utility Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.11 Connecting the Nurse Call Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Operating Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 7.2 7.3 7.4 7.5 7.6 7.7 ii Turning on the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setup Menu Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2.1 Accessing Setup Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2.2 Changing the Setup Menu Parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2.3 Exiting the Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preferences Menu Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.1 Preferences Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.2 Backlight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.3 Contrast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.4 Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.5 Key Sound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.6 Apnea Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.7 Disconnection Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.8 Pediatric Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3.9 Ventilation Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting the Ventilation Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4.1 Changing Modes While Ventilation is on Standby . . . . . . . . . . . . . . . . . . . . . 7.4.2 Changing Modes During Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Ventilation Parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5.1 Links between Ventilation Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5.2 Links between Ventilation and Alarm Parameters . . . . . . . . . . . . . . . . . . . . . Setting Alarm Parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . USB Menu Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6–1 6–1 6–2 6–4 6–6 6–6 6–7 6–10 6–11 6–12 6–12 6–13 6–15 6–16 6–17 6–18 7–1 7–1 7–3 7–3 7–4 7–9 7–9 7–9 7–11 7–11 7–12 7–13 7–13 7–14 7–14 7–15 7–15 7–16 7–16 7–19 7–20 7–20 7–20 7–22 Clincian’s Manual Contents 7.7.1 USB Memory Device Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7.2 USB Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7.3 Transfer Continuously . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7.4 Transfer Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7.5 Erase Data from the USB Memory Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 Locking the Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.9 Unlocking the Control Panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.10 Starting Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.11 Stopping Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.12 Turning Off the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Internal Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1 8.2 8.3 8.4 8.5 Battery Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Battery Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Testing the Battery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recharging the Battery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.1 9.2 9.3 Cleaning the Ventilator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cleaning the Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cleaning the Ventilator Between Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Routine Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.1 10.2 10.3 B.1 B.2 B.3 B.4 Replacing the Air Inlet Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recommended Schedule of Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Service Assistance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Electrical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Indicators and Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.4.1 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.5 Monitored Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.6 Range, Resolution, and Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.7 Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.8 USB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.9 Pneumatic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.10 Manufacturer’s Declaration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.11 Standards Compliance and IEC Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C.1 Architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C.2 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.1 Modes of Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.1.1 Assist/Control (A/C) Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.1.2 CPAP Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.1.3 PSV Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.2 Breath Types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.2.1 Pressure Control Breaths in Assist/Control Mode. . . . . . . . . . . . . . . . . . . . . . . D.2.2 Pressure Supported Breaths in PSV Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.2.3 CPAP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clincian’s Manual 7–23 7–23 7–23 7–24 7–26 7–27 7–27 7–28 7–29 7–30 8–1 8–1 8–2 8–4 8–4 8–5 9–1 9–1 9–2 9–2 10–1 10–1 10–2 10–3 B–1 B–1 B–3 B–3 B–3 B–3 B–5 B–7 B–7 B–8 B–9 B–13 C–1 C–1 D–1 D–1 D–1 D–1 D–1 D–1 D–2 D–3 iii Contents D.3 D.4 F.1 F.2 F.3 F.4 F.5 F.6 iv Ventilation Modes and Apnea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D–3 VT Target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D–4 Low Pressure Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F–1 Apnea Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F–2 Power Failure Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F–2 Occlusion Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F–2 Testing the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F–3 Involuntary Stop Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F–4 Clincian’s Manual Figures Figure 1-1. Figure 1-2. Figure 1-3. Figure 2-1. Figure 2-2. Figure 2-3. Figure 2-4. Figure 2-5. Figure 2-6. Figure 3-1. Figure 3-2. Figure 3-3. Figure 3-4. Figure 3-5. Figure 3-6. Figure 3-7. Figure 4-1. Figure 4-2. Figure 4-3. Figure 4-4. Figure 4-5. Figure 4-6. Figure 4-7. Figure 5-1. Figure 5-2. Figure 5-3. Figure 5-4. Figure 5-5. Figure 5-6. Figure 5-7. Figure 5-8. Figure 6-1. Figure 6-2. Figure 6-3. Figure 6-4. Figure 6-5. Figure 6-6. Figure 6-7. Clinician’s Manual Locations of Labels – Top-Front View. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–16 Location of Labels and Markings – Rear View . . . . . . . . . . . . . . . . . . . . . . . . . 1–16 Location of Labels – Bottom View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–17 Front Panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2–4 Back Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2–5 Control Panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2–6 Ventilation Menu Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2–7 Alarm Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2–8 USB Memory Device Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2–9 Menus in PSV Mode with Exhalation Valve Configuration . . . . . . . . . . . . . . 3–1 Menus in PSV Mode with Leakage Configuration . . . . . . . . . . . . . . . . . . . . . . 3–2 Exhalation Trigger Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–4 Menus in CPAP Mode in Leakage Configuration . . . . . . . . . . . . . . . . . . . . . . . 3–7 Menus in P A/C Mode with Exhalation Valve Configuration. . . . . . . . . . . . . 3–9 Menus in P A/C Mode with Leakage Configuration. . . . . . . . . . . . . . . . . . . . . 3–9 Fi02 for Oxygen and Ventilator Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–13 Ventilation Menu: Pressure Leakage Configuration Modes (CPAP, PSV ST, P A/C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–1 Ventilation Menu: Pressure Valve Configuration Modes (PSV ST, P A/C) . 4–1 Alarm Menu: Pressure Leakage Modes (CPAP, PSV ST, P A/C) . . . . . . . . . . . 4–2 Alarm Menu: Pressure Valve Modes (PSV ST, P A/C) . . . . . . . . . . . . . . . . . . . . 4–2 Inspiratory Effort Detected Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–2 Bargraph Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–4 Ventilation Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–4 Alarm Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–2 Accessing Alarm Log Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–3 Displaying the Alarm Log Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–3 Alarm Log Display when No Alarm Activated . . . . . . . . . . . . . . . . . . . . . . . . . . 5–4 Silencing the Audible Portion of Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–4 Manually Pausing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–5 Reactivating Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–6 Alarm Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5–6 The Power Cable Holder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6–2 Inserting the Power Cable Holder Into the Notch . . . . . . . . . . . . . . . . . . . . . . 6–3 Power Cable Connected to the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6–3 Power Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6–4 Connecting the Ventilator to an External DC Power Source . . . . . . . . . . . . 6–5 Connecting the DC Power Cable to the Ventilator . . . . . . . . . . . . . . . . . . . . . 6–5 Single Limb Patient Circuit With Exhalation Valve . . . . . . . . . . . . . . . . . . . . . 6–7 v Figures Figure 6-8. Figure 6-9. Figure 6-10. Figure 6-11. Figure 6-12. Figure 6-13. Figure 6-14. Figure 6-15. Figure 6-16. Figure 6-17. Figure 6-18. Figure 6-19. Figure 7-1. Figure 7-2. Figure 7-3. Figure 7-4. Figure 7-5. Figure 7-6. Figure 7-7. Figure 7-8. Figure 7-9. Figure 7-10. Figure 7-11. Figure 7-12. Figure 7-13. Figure 7-14. Figure 7-15. Figure 7-16. Figure 7-17. Figure 7-18. Figure 7-19. Figure 7-20. Figure 7-21. Figure 7-22. Figure 7-23. Figure 7-24. Figure 7-25. Figure 7-26. Figure 7-27. Figure 7-28. Figure 7-29. Figure 7-30. Figure 7-31. Figure 7-32. Figure 7-33. Figure 7-34. Figure 7-35. Figure 7-36. Figure 7-37. vi Close-up of Exhalation Valve Tube and Proximal Pressure Tube . . . . . . . . Single Limb Patient Circuit Without Exhalation Valve. . . . . . . . . . . . . . . . . . . Air Inlet Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bacteria Filter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Humidifier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rear Panel Oxygen Connector. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Connecting the Oxygen Supply System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disconnecting the Oxygen Supply System. . . . . . . . . . . . . . . . . . . . . . . . . . . . Using the Dual Bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mounting the Ventilator on the Utility Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . Using the Utility Cart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Connecting the Nurse Call Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Turning on the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Welcome Menu Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Menu Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Absolute and Relative Pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E Sens Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Resetting Patient Hours to Zero (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Resetting Patient Hours to Zero (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Resetting Patient Hours to Zero (3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Resetting Patient Hours to Zero (4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting the Preferences Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Changing Settings in the Preferences Menu . . . . . . . . . . . . . . . . . . . . . . . . . . Modifying the Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Increasing the Contrast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Decreasing the Contrast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Increasing the Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Decreasing the Alarm Volume. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting the Apnea Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accessing the Ventilation Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Changing Ventilation Modes While on Standby . . . . . . . . . . . . . . . . . . . . . . . Changing Ventilation Modes During Ventilation . . . . . . . . . . . . . . . . . . . . . . Displaying Active and Inactive Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Changing the Settings of the New Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Changing Ventilation Modes and Parameters . . . . . . . . . . . . . . . . . . . . . . . . . Modifying a Ventilation Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Links Between Ventilation Parameters . . . . . . . . . . . . . . . . . . . . . . . . Modifying Alarm Parameters – Min Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Modifying Alarm Parameters – Max Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting the USB Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting Transfer Continuously. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting Transfer Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Erasing Data from the USB Memory Device . . . . . . . . . . . . . . . . . . . . . . . . . . . Enabling the Locking Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prompt to Start Ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Starting Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stopping Ventilation (1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stopping Ventilation (2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6–8 6–9 6–10 6–11 6–11 6–13 6–14 6–14 6–16 6–17 6–17 6–18 7–2 7–2 7–3 7–3 7–6 7–7 7–7 7–8 7–8 7–8 7–9 7–10 7–10 7–11 7–12 7–12 7–12 7–14 7–15 7–16 7–17 7–17 7–18 7–18 7–19 7–20 7–21 7–21 7–23 7–24 7–25 7–26 7–27 7–28 7–29 7–29 7–30 Clinician’s Manual Figures Figure 8-1. Figure 8-2. Figure 8-3. Figure 8-4. Figure 10-1. Figure C-1. Figure D-1. Figure D-2. Figure D-3. Figure D-4. Figure D-5. Figure F-1. Figure G-1. Figure G-2. Clinician’s Manual Internal Battery Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Battery Reserve Capacity as a Percentage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Battery Reserve Capacity in Hours and Minutes. . . . . . . . . . . . . . . . . . . . . . . . . Power Indicators When Charging the Battery. . . . . . . . . . . . . . . . . . . . . . . . . . . Replacing the Air Inlet Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gas Delivery System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Flow Patterns in P A/C Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Controlled Machine Breaths in P A/C Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . Pressure Supported Breaths in PSV Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Flow Patterns in CPAP Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target Volume in Pressure Modes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blocking the Patient End of a Single Limb Circuit . . . . . . . . . . . . . . . . . . . . . . . Puritan Bennett™ 520 Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dual Bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8–2 8–3 8–3 8–4 10–2 C–2 D–2 D–2 D–3 D–3 D–4 F–3 G–2 G–2 vii Figures This page is intentionally blank viii Clinician’s Manual Tables Table 1-1. Table 1-2. Table 3-1. Table 3-2. Table 3-3. Table 3-4. Table 3-5. Table 3-6. Table 4-1. Table 5-1. Table 5-2. Table 5-3. Table 7-1. Table 7-2. Table 7-3. Table 8-1. Table 9-1. Table 10-1. Table A-1. Table B-1. Table B-2. Table B-3. Table B-4. Table B-5. Table B-6. Table B-7. Table B-8. Table B-9. Table B-10. Table B-11. Table B-12. Table B-13. Table B-14. Table B-15. Table B-16. Table B-17. Table B-18. Table B-19. Table B-20. Clinician’s Manual Ventilator Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilator Labels and Markings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Parameters in PSV Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Parameters in PSV Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Parameters in CPAP Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Parameters in CPAP Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Parameters in P A/C Mode Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Parameters in P A/C Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Displayed Monitored Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview of Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarms and Corrective Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional Troubleshooting and Corrective Actions. . . . . . . . . . . . . . . . . . . Languages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . USB Memory Device Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Trends Data Transfer Time from Ventilator to USB Memory Device . . . . Internal Battery Reserve Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Approved Cleaning Solutions for Exterior Ventilator Surfaces . . . . . . . . . . Consumables and Replacement Intervals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient/Caregiver Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physical Description (Excluding Accessories) . . . . . . . . . . . . . . . . . . . . . . . . . . AC Electrical Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Internal Lithium Ion Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remote Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Power Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Audio Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Performance Parameter Specifications and Tolerances. . . . . . . . . . . . . . . . . Monitored Parameter Specifications and Tolerances . . . . . . . . . . . . . . . . . . . Ventilator Range, Resolution, and Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . Environmental Conditions for Storage or Transport . . . . . . . . . . . . . . . . . . . . Environmental Conditions for Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . USB Memory Device Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Data Transfer Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Airway Resistances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Air Inlet Resistance (Filter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oxygen Inlet Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Electromagnetic Emissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Electromagnetic Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–11 1–14 3–2 3–2 3–7 3–7 3–9 3–10 4–3 5–7 5–14 5–21 7–5 7–23 7–25 8–1 9–1 10–2 A–1 B–1 B–1 B–1 B–2 B–3 B–3 B–3 B–3 B–3 B–5 B–7 B–7 B–7 B–8 B–8 B–8 B–8 B–8 B–9 B–10 ix Tables Table B-21. Table B-22. Table B-23. Table D-1. Table E-1. Table H-1. Table H-2. x Electromagnetic Immunity – Conducted and Radiated RF . . . . . . . . . . . . . B–11 Recommended Separation Distances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B–12 Compliant Cables and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B–13 Volume target measurements in pressure modes . . . . . . . . . . . . . . . . . . . . . . D–4 Operational Verification Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E–1 List of Consumables and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H–1 List of Circuits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H–2 Clinician’s Manual Purpose of This Manual Preface Purpose of This Manual This manual contains important information regarding the safe operation of your Puritan Bennett™ 520 Ventilator. Your ventilator is an electrical device that can provide years of useful service with the proper care, as described in this manual. Ensure that you read and understand the instructions contained in this manual before operating the ventilator. WARNING Before operating the ventilator, read, understand, and strictly follow the information contained in Chapter 1, “Safety Information”. Qualification of Personnel Installation and maintenance of the device must be made by authorised and trained personnel. In particular, training for the handling of products sensitive to electrostatic discharges must include the use of Electrostatic Discharge (ESD) protection devices and knowledge of the following symbol’s , as well as using original spare parts and respecting quality assurance and traceability meaning: rules approved by Covidien. Warranty Information regarding your product warranty is available from your sales representative or Covidien. Extended Service The Puritan Bennett™ 520 Ventilator offers extended service contracts/warranties for purchase when the ventilator is purchased. Please contact your local Covidien Sales or Service Representative for additional information. For online technical support, visit the SolvITSM Center Knowledge Base by clicking the link at http://www.respiratorysolutions.covidien.com. Here, you will find answers to frequently asked questions about the product and other Covidien products 24 hours a day, 7 days a week. If you require further assistance, contact your local Covidien representative. Clinician’s Manual Preface-1 Preface Technical Support Technical Service Contacts: Covidien Argentina Aguero 351 Capital Federal - 1171 ABC, Argentina Tel: (5411) 4863-5300 Fax: (5411) 4863-4142 Covidien Belgie S.A.-N.V. Generaal De Wittelaan 9/5 Mechelen 2800 België Tel +32 152 981 37 Fax +32 152 167 83 Covidien Chile Rosario Norte 530, Piso 12 Las Condes Santiago de Chile, Chile Tel: (562) 231-3411 Fax: (562) 231-3527 Covidien Czech Republic Vyskocilova 1410/1 140 00 Praha Ceska Republika Tel +42 024 109 57 35 Fax + 42 02 3900 0437 Covidien ECE Galvaniho 7/a 821 04 Bratislava Slovenska Republika Tel +42 124 821 45 73 Fax +42 124 821 45 01 Covidien Hungary 1095 Budapest Mariassy u. 7 Magyarorszag Hungary Tel + 36 1880 7975 Fax + 36 1777 4932 Preface-2 Covidien Australia 52A Huntingwood Drive Huntingwood, NSW 2148 Australia Telephone (+61) 1800 350702 Fax +612 9671 8118 Covidien Brazil Av. Nações Undias 23013-A Vila Almeida São Paulo, SP Brasil 04795-100 Tel: (5511) 5683-8300 Fax: (5511) 5683-8349 Covidien Colombia Edificio Prados de la Morea Carretera Central Del Norte (Cra 7a) Kilometro 18, Chia-Cundinamarca Bogota, Colombia Tel: (571) 619-5469 Fax: (571) 619-5425 Covidien Danmark A/S Langebrogade 6E, 4. sal 1411 København K Danmark Tel +45 702 753 50 Fax:+45 702 756 50 Covidien Finland Oy Läkkisepäntie 23 00620 Helsinki Finland Te. +35 896 226 84 10 Fax +35 896 226 84 11 Covidien Ireland Commercial Ltd Block G, Ground Floor, Cherrywood Technology Park, Loughlinstown County Dublin Ireland Tel +353 1 4381613 Covidien Austria GmbH Campus21 Europaring F09402 Brunn am Gebrige A-2345 Österreich +43 223 637 88 39 +43 223 637 88 39 40 Covidien Canada 19600 Clark Graham Baie d'Urfe, QC, H9X 3R8 Canada Tel:1-514-695-1220, Ext.4004 Fax: 1-514-695-4965 Covidien Costa Rica La Uruca 75 Metros al Oseste de Faco Oficentro La Virgen, Edificio "I" San Jose, Costa Rica Tel: (506) 256-1170 Fax: (506) 256-1185 Fax: (506) 290-8173 Covidien Deutschland GmbH Technisches Service Center Raffineriestr. 18 93333 Neustadt / Donau Germany Tel + 49 944 595 93 80 Fax + 49 944 595 93 65 Covidien France SA Parc d’affaires Technopolis Bat. Sigma, 3 Avenue du Canada LP 851 Les Ulis 91975 Courtaboeuf Cedex France Tel +33 169 821 400 Fax +33 169 821 532 Covidien Israel 5 Shacham St. North Industrial Park Caesarea 38900 Israel Tel +97 246 277 388 Fax+97 266 277 688 Clinician’s Manual Technical Support Technical Service Contacts: Covidien Italia S.p.A. Via Rivoltana 2/D 20090 Segrate Italy Tel +39 027 031 72 61 Fax +39 027 031 72 84 Covidien Nederland BV Hogeweg 105 5301 LL Zaltbommel Nederland Tel +31 41 857 66 68 Fax +31 41 857 67 96 Covidien Polska Al. Jerozolimskie 162 Warszawa. 02-342 Polska Tel +48 223 122 130 Fax +48 223 122 020 Covidien Russia 53 bld. 5 Dubininskaya Street Moscow RUSSIA. 119054 России Tel +70 495 933 64 69 Fax +70 495 933 64 68 Covidien Spain S.L. c/Fructuós Gelabert 6, pl. Sótano 08970 Sant Joan Despí Barcelona, Spain Tel +34 93 475 86 69 Fax +34 93 373 87 10 Covidien UK and Ireland Unit 2, Talisman Business Park London Road, Bicester OX26 6HR, United Kingdom Tel +44(0)1869 328092 Fax +44(0)1869 327585 Clinician’s Manual Covidien Japan Inc. Technical Support Center 83-1, Takashimadaira 1-Chome Itabashi-ku, Tokyo 175-0082 Japan Tel: +81 (0) 3 6859 0120 Fax: +81 (0) 3 6859 0142 Covidien Norge AS Postboks 343 1372 Asker. Norway Tel +47 668 522 22 Fax +47 668 522 23 Covidien Portugal Lda. Estrada do Outeiro de Polima, Lote 10-1° Abóboda 2785-521 S.Domingos de Rana Portugal Tel +35 121 448 10 36 Fax +35 121 445 1082 Covidien Saglik A.S. Maslak Mahallesi Bilim Sokak No: 5, Sun Plaza Kat: 2-3 Sisli, Istanbul 34398 Turkey Tel +90 212 366 20 00 Fax +90 212 276 35 25 Covidien Sverige AB Box 54 171 74 Solna Sweden Tel +46 858 56 05 00 Fax + 46 858 56 05 29 Covidien Mexico Calz.Ermita Iztapalapa 1514 Col. Barrio San Miguel Del. Iztapalapa Mexico, D.F. 09360 Mexico Tel: (5255) 5804-1524 Fax: (5255) 5685-1899 Covidien Panama Parque Industrial Costa del Esta Calle Primera, Edifio # 109 Panama City, Panama Tel: (507) 264-7337 Fax: (507) 236-7408 Covidien Puerto Rico Palmas Industrial Park Road 869 Km 2.0 Bdlg. #1 Cataño, PR 00962 Tel. 787-993-7250 Ext. 7222 or 7221 Fax 787-993-7234 Covidien South Africa Corporate Park North 379 Roan Crescent Randjespark Midrand, South Africa Tel +27 115 429 500 Fax +27 115 429 547 Covidien Switzerland Roosstr. 53 Wollerau 8832 Schweiz Tel +41 17865050 Fax +41 17865010 Asia: Tyco Healthcare Pte Ltd Singapore Regional Service Centre 15 Pioneer Hub, #06-04 Singapore 627753 Tel (65) 6578 5187 / 8 / 9 Fax (65)6515 5260 Email: [email protected] Preface-3 Preface This page intentionally blank Preface-4 Clinician’s Manual Definitions 1 Safety Information 1.1 Definitions This manual uses three indicators to highlight critical information: Warning, Caution, and Note. They are defined as follows: WARNING Indicates a condition that can endanger the patient or the ventilator operator. Caution Indicates a condition that can damage the equipment. Note: Indicates points of particular emphasis, that make operation of the ventilator more efficient or convenient. It is essential to read, understand and follow these instructions before using the Puritan Bennett™ 520 Ventilator. In order to use the ventilator correctly and efficiently and to help prevent incidents, please pay particular attention to section 1.2, “Warnings” , as well as all warnings and cautions contained throughout this manual. 1.2 Warnings Fire Hazard Warnings • • The ventilator must not be used with flammable anesthetic substances. • Never expose any batteries to direct flame. • In the event of an oxygen leak, shut down the supply of oxygen at its source. In addition, remove and/or keep any incandescent source away from the device, which may be enriched with oxygen. Circulate fresh air into the room to reduce the oxygen concentration level. To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses. Warnings about Reducing Infection • To reduce the risk of infection, wash your hands thoroughly before and after handling the ventilator or its accessories. • A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection. • • Single Use accessories Clinician’s Manual should not be reused. The air inlet filter is for use on a single patient and is not reusable; do not attempt to wash, clean, or reuse it. 1-1 Safety Information Warnings before Using Equipment • • The ventilator must be used only under the responsibility and on the prescription of a doctor. • • The ventilator must be used according to its intended use. Refer to 2.1, “Indications for Use”. • Before dispensing the ventilator to caregivers or the patient for home use, ensure the Locking Key is activated so that critical ventilator settings are not modified. • Do not perform ventilator alarm tests while the patient is connected to the ventilator. Provide the patient with an alternate means of ventilation before conducting these tests. • Verify the functionality of the alarm conditions before connecting the patient to the ventilator. Refer to Appendix F, “Alarms Tests”. • If the ventilator fails the alarm tests or if you cannot complete the tests, refer to section 5.8, “Troubleshooting” or call your equipment supplier or Covidien. • The default setting for altitude compensation is YES. Altitude compensation should always be set to YES for accurate volume delivery calculations at all elevations. • Before starting ventilation, ensure that the device is properly assembled and that the air inlet, cooling vents, and alarm sound diffusion holes are not obstructed. Ensure also that the patient circuit is of the proper configuration, properly connected to the ventilator, and that the circuit hoses are neither damaged nor compressed and contain no obstructions or foreign bodies. • This ventilator offers a choice of breath delivery modes and types. Throughout the patient’s treatment, the clinician should carefully select the ventilation mode and/or breath type to use for that patient. This selection should be based on the clinician’s clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time, and considering the benefits, limitations and operating characteristics of each mode and/or breath type. • Patients on home care ventilation equipment should be appropriately monitored by clinicians, caregivers and suitable monitoring equipment, as advised by the patient’s clinician. The Puritan Bennett™ 520 Ventilator is not intended to be a comprehensive monitoring device and does not activate alarms for all types of dangerous conditions for patients. The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent. Do not start ventilation until you ensure that the device is suitably assembled, that the air inlet filter is properly installed and is not obstructed, and that there is proper clearance all around the unit. Also ensure that the patient circuit is suitably connected to both the ventilator and the patient and that the patient circuit, including all hoses, is not damaged or obstructed. Warnings regarding Environment of Use 1-2 • Do not operate the ventilator in direct sunlight, near heat sources, outdoors, or near installations where liquid may pose a risk without first providing adequate protection for the device. • Avoid using the ventilator, if possible, in dusty environments. Dusty environments may require more vigilant monitoring, cleaning, and/or replacement of air intake and other filters. • Ensure that the ventilator’s immediate surroundings allow for the proper operational connection of the device without folding, pinching, or damaging any of the required cables or tubes, and that the connection of the patient circuit to the patient provides for a secure, comfortable fit. • Place the ventilator in a safe place when ventilating and according to the recommendations in this manual. • Do not place the ventilator in a position where a child can reach it or in any position that might cause it to fall on the patient or someone else. • To ensure correct and lasting operation of the ventilator, ensure that its air circulation holes (main inlet or cooling) are never obstructed. Place the device in an area where air can freely circulate around the ventilator and avoid installing it near floating fabrics, such as curtains. Clinician’s Manual Warnings • If the ventilator has been transported or stored at a temperature that differs more than 20 °C ( 36 °F) from the temperature in which it will be operating, the ventilator should be allowed to stabilise in its operating environment for at least two (2) hours prior to use. • If the ambient temperature where the device is operated is greater than 35 °C (95 °F), the flow supplied at the device outlet may exceed 41 °C (106 °F). This may lead to undesirable side effects for the patient. To avoid injury to the patient move the patient and the ventilator to a cooler location. • The default setting for altitude compensation is YES. Altitude compensation should always be set to YES for accurate volume delivery calculations at all elevations. • To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses. • Before starting ventilation, ensure that the device is properly assembled and that the air inlet, cooling vents, and alarm sound diffusion holes are not obstructed. Ensure also that the patient circuit is of the proper configuration, properly connected to the ventilator, and that the circuit hoses are neither damaged nor compressed and contain no obstructions or foreign bodies. • Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over (see chapter 10, “Routine Maintenance”). This is particularly important when the ventilator is installed on a wheelchair, because environmental conditions may cause the filter to become dirty more rapidly. • Due to typical voltage fluctuations that occur during normal power wheelchair use, the wheelchair mains battery should never be used to power the Puritan Bennett™ 520 Ventilator. The ventilator should always be connected to an independent power source (e.g. AC power, extra batteries, or DC power source). • Handle the ventilator with care during and after use, particularly when ambient temperatures are high. Some ventilator surfaces may become hot, even if safety specifications are not exceeded. • Alarm volume should be adjusted with respect to the ventilator’s operating environment and so that the patient's caretakers can hear the alarms. See 7.3.4, “Alarm Volume”. The audible alarm vents located at the front of the device should never be obstructed. Warnings Regarding Electromagnetic Interference • The Puritan Bennett™ 520 ventilator requires special precautions for electromagnetic compatibility and should be installed and started according to the recommendations found in Appendix B, “Specifications.” In particular, the use of nearby mobile and portable communications equipment using radio frequencies, such as mobile telephones or other systems exceeding the levels set in the IEC 60601-1-2 standard, may affect its operation. Refer to section B.10, “Manufacturer’s Declaration”. • The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation. Warnings regarding Settings • Before starting ventilation, always verify that all settings are properly set in accordance with the required prescription. • The Puritan Bennett™ 520 Ventilator offers a variety of breath delivery modes. Throughout the patient’s treatment, the clinician should carefully select the ventilation mode or modes to use for that patient. This selection should be based on the clinician's clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time, and considering the benefits, limitations and operating characteristics of each mode. • The CPAP mode does not provide a set respiratory rate. Do not use this mode if it is not appropriate for the patient’s condition. Clinician’s Manual 1-3 Safety Information • Alarm volume should be adjusted with respect to the ventilator’s operating environment and so that the patient's caretakers can hear the alarms. See 7.3.4, “Alarm Volume”. • Ensure that the I Sens setting is not set to OFF when ventilating patients capable of triggering spontaneous breaths. • Monitor the patient's state of health in order to ensure that the ventilator’s settings are always suited to the patient’s current physiological requirements. • In adult or pediatric use ensure that the adjusted tidal volume is compatible with the needs of the patient. • When changing the mode during ventilation, significant transitions of pressure, flow or cycling rate might occur, depending on the difference between the modes. Before setting the new mode, first ensure that the settings between the different modes are compatible. This reduces the risk of discomfort and harm to the patient. • The setting of the Min PIP alarm must be adjusted for the patient, but must also be set high enough to allow the PATIENT DISCONNECTION alarm to trigger properly. Perform the Low Pressure Test (refer to section F.1, “Low Pressure Test”) to ensure the Min PIP alarm is properly set. • • • • • If APNEA TIME is set to a value higher than 60/Control R then the APNEA alarm will not activate. • The inspiration trigger threshold should be carefully modified in order to avoid the risk of false triggering or “autotriggering” of the ventilator. For example, Level 1P, the most sensitive mode, is recommended for pediatric use. However, for an adult, this setting may result in autotriggering. The Apnea Alarm should be set to YES if an audible alarm sound is desired when apnea events occur. Setting Alarm limits to extreme values can cause the ventilator alarms to malfunction. Ensure the I Time setting is compatible with the physiological requirements of the patient. Adjustable alarms should not be systematically cancelled; instead, they should be adjusted according to the needs and condition of the patient. Warnings Applicable during Use of Equipment 1-4 • • • The ventilator must be used only under the responsibility and on the prescription of a doctor. • Be aware this manual describes how to respond to the ventilator, but it does NOT tell you how to respond to the patient. • While the ventilator is in use, an alternative means of ventilation should always be available in the event of a ventilator problem. Supplementary observation, appropriate for the patient's condition, is also recommended. • Patients should always be monitored by trained and competent medical personnel. Ensure that the patient’s caregiver is able and prepared to take suitable action in the event the ventilator identifies an alarm condition or experiences a problem. • When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator. • A continuous alarm condition will be activated if the ventilator power switch is turned off while ventilation is in progress. When the power switch is turned back on again, ventilation will resume without having to press the VENTILATION ON/OFF button. • If the device is damaged, its external housing is not correctly closed, or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odour, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately. The ventilator must be used according to its intended use. Refer to section 2.1, “Indications for Use”. The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent. Clinician’s Manual Warnings • Handle the ventilator with care during and after use, particularly when ambient temperatures are high. Some ventilator surfaces may become hot, even if safety specifications are not exceeded. • Even though the Puritan Bennett™ 520 Ventilator meets current safety standards, and although the internal Lithium-ion battery of the device is considered to be Dangerous Goods for transport in commerce, this devices lithium battery is below the 100Wh threshold and is therefore excepted from being a Class 9 – Miscellaneous - Dangerous Goods (DG). As such, the Puritan Bennett™ 520 Ventilator and/or the associated Lithium-ion battery are subject to some transport conditions under the Dangerous Goods Regulation for air transport (IATA: International Air Transport Association), International Maritime Dangerous Goods code for sea and the European Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) for Europe. Private individuals who transport the device are excluded from these regulations although for air transport some requirements apply. For air transport; the Puritan Bennett™ 520 Ventilator is permitted as checked-in or carry-on baggage. Spare batteries may be taken on board as carry-on luggage only. This classification and regulatory requirements may vary depending upon the country and mode of transport. Therefore it is recommended that users verify with the carrier / airline as to which measures to take before the voyage. • To minimise the risk of damage, you must use the ventilator’s Dual Bag to transport the ventilator. See Table H-1, “List of Consumables and Accessories”. • To ensure that ventilation continues uninterrupted, ensure alternative power sources are available (AC power source, extra batteries, or an auxiliary DC car adapter). Be prepared for the possibility of power failure by having an alternative means of ventilation ready for use. • • The ventilator must not be used with flammable anaesthetic substances. • To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator. • To ensure correct and lasting operation of the device, ensure that the ventilator is installed and operated in the environmental conditions recommended in Appendix B, “Specifications” • • Do not leave power cables lying on the ground where they may pose a hazard. • Do not conduct the ventilator alarm test while the patient is connected to the ventilator. Switch the patient to an alternate means of ventilation before testing. The ventilator should never be immersed in any liquid, and any liquid on the surface of the device should be wiped away immediately. Do not allow a patient to remain connected to the ventilator when ventilation is stopped, because a substantial quantity of exhalation gas, primarily carbon dioxide, may be inhaled by the patient. In some circumstances, inhaling carbon dioxide may lead to under ventilation, suffocation, and serious injury or death. Warnings regarding Electrical Power • To ensure that ventilation continues uninterrupted, ensure alternative power sources are available (AC power source, extra batteries, or an auxiliary DC car adapter). Be prepared for the possibility of power failure by having an alternative means of ventilation ready for use. • Never connect your ventilator to an electrical outlet controlled by a wall switch because the power may be inadvertently turned off. • To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator. • Do not leave power cables lying on the ground where they may pose a hazard. Clinician’s Manual 1-5 Safety Information 1-6 • Due to typical voltage fluctuations that occur during normal power wheelchair use, the wheelchair mains battery should never be used to power the Puritan Bennett™ 520 Ventilator. The ventilator should always be connected to an independent power source. (e.g. AC power, extra batteries, or DC power source) • The operator should connect the ventilator to an AC power source whenever available, for safer operation. • The maximum recommended shelf life of the internal battery is two (2) years. Do not use a battery that has been stored for two years, or more, prior to its first use. • Periodic recharging is important to help maximise useful life of the battery. Do not store the internal battery for extended periods, without recharging, as this may reduce the maximum life. • For the AC (“mains”) power cable to be properly secured, the attachment located on the power cable must be fitted into the power cable holder incorporated in the battery access cover and located under the AC (mains) power socket. Refer to section 6.2, “Connecting to External AC Power” • The power supply to which the ventilator is connected (both AC and DC) must comply with all applicable standards and provide electrical power corresponding to the voltage characteristics inscribed on the rear of the ventilator to ensure correct operation. Refer also to the electrical specifications found in Appendix B, “Specifications” • Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12– 30 VDC power source (via the DC power cable) does not enable its internal battery to recharge. • Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged. • When using a car auxiliary adapter (cigarette lighter) ensure the car has been started prior to plugging in the ventilator’s DC adapter. Refer to section 6.3, “Connecting to an External DC Power Source” • Even if the “INTERNAL BATTERY” charging indicator is off, charging of the battery may sometimes be incomplete if the ambient temperature is above 40 °C (104 °F) because of the battery’s internal heat safety device. • When the “LOW BATTERY“ alarm is triggered, immediately connect the ventilator to an AC power supply to maintain ventilation and recharge the internal battery. • • Batteries should be disposed of according to environmental legislation in your country and locality. • A continuous alarm condition will be activated if the ventilator power switch is turned off while ventilation is in progress. When the power switch is turned back on again, the ventilation will resume without having to press the VENTILATION ON/OFF button. • Before using the ventilator’s internal battery, ensure that the battery is fully charged and that the charge holds. Back up ventilators or those in storage should be connected to an AC power source to protect the integrity of the battery. • To connect the ventilator to an external power source, first connect the desired power cable to the ventilator. Then connect the power cable to the external power source. • To disconnect the ventilator from an external power source, first disconnect the power cable from the external power source and then, the ventilator. • Connect the external DC power source by first connecting the power cable to the ventilator and then to the external DC source. Follow the reverse procedure to disconnect the device from the external DC power source. Ensure that the AC power cable is in perfect condition and not compressed. The device should not be turned on if the AC power cable is damaged. Clinician’s Manual Warnings Warnings regarding Oxygen • Oxygen therapy for patients with respiratory failure is a common and effective medical prescription. However, be aware that inappropriate oxygen use may potentially lead to serious complications, including, but not limited to, patient injury. • Strictly follow the instructions provided in section 6.7.2 , “Connecting the Oxygen Supply”, which include the use of a special oxygen connector. • To avoid injury to the patient and/or possible damage to the ventilator: before connecting the ventilator to the oxygen supply, ensure a flow meter (flow regulator) is connected to the ventilator to regulate the oxygen supply to the required specification. • If using oxygen with the Puritan Bennett™ 520 Ventilator, Covidien recommends using an oxygen analyser with minimum and maximum concentration alarms. Always measure the delivered oxygen with a calibrated oxygen analyser that features a minimum and maximum concentration alarm in order to ensure that the prescribed oxygen concentration is delivered to the patient. • The Puritan Bennett™ 520 Ventilator is designed to deliver a percentage of oxygen equal to or lower than 50%. Do not exceed this value as this may cause the ventilator to malfunction and put the patient at risk. • Ensure that the oxygen supply pressure to the machine never exceeds 7 psi (50 kPa) or a flow of 15 lpm. Refer to Table B-8 on page B-3 for sensitivity tolerances. • In the event of an oxygen leak, shut down the supply of oxygen at its source. In addition, remove and/or keep any incandescent source away from the device, which may be enriched with oxygen. Circulate fresh air into the room to bring the oxygen level down to normal. • The hose connecting the ventilator to the oxygen source must be designed exclusively for use with medical-grade oxygen. Under no circumstances should the oxygen hose be modified by the user. In addition, the hose must be installed without the use of lubricants. • Ensure that the only gas supplied to the ventilator through the dedicated oxygen supply connector is medical-grade oxygen. • The coupler must not remain connected to the oxygen connector unless it also connected to a leakproof, external oxygen gas source. When an oxygen supply is not being used with the ventilator, disconnect the oxygen source completely from the ventilator. • To ensure stability, when the Puritan Bennett™ 520 Ventilator is mounted on a cart, the weight of the oxygen bottle should not exceed 14 kg (30 lbs). • The oxygen supply hose ages even when it is not in use and should be replaced periodically. The expiration date may be located on the back of the hose end-piece. • The oxygen supply must be regulated using a flow meter connected to the source gas outlet. • The oxygen supply must be shut off when ventilation is interrupted. Before disconnecting the oxygen hose, allow the ventilator to continue for a few cycles without oxygen to flush the patient circuit of excess oxygen. • Before connecting the oxygen supply, ensure that the stud on the oxygen connector is protruding outwards. • Inspect the oxygen coupler before use to ensure it has its black o-ring attached and in good condition. Do not use an oxygen coupler with a missing, damaged, or worn o-ring. Warnings regarding Hoses and Accessories • The ventilator must not use, nor be connected to, any anti-static or electrically conductive hoses, tubing, or conduits. • Before opening the packaging for the Patient Circuit, ensure that no damage is evident to the packaging or its contents. Do not use if evidence of damage exists. Clinician’s Manual 1-7 Safety Information 1-8 • • The patient circuit should not be changed during ventilation. • • Single Use • The air inlet filter is for use on a single patient. It is not reusable; do not attempt to wash, clean, or reuse it. • Failing to replace a dirty air inlet filter, or operating the ventilator without a filter, may cause serious damage to the ventilator. • The patient circuit should always be positioned to avoid hindering the patient's movements, to prevent accidental disconnection or leakage, and to minimise the risk of patient strangulation. • For pediatric use, ensure that the patient circuit type fits, and, in all respects, is suitable for use with a child. Use a pediatric circuit for patients that weigh under 53 lb. (23 kg). To ensure proper performance of the ventilator, see Table H-2, List of Circuits, on page H-2, for a list of recommended patient circuits. • The exhalation valve must allow rapid discharge of the circuit pressure. Ensure that the exhalation valve is always clean and its evacuation aperture (exhaust port) is never obstructed. • Users must always possess an additional breathing circuit and exhalation valve while using the ventilator. • Always ensure that the humidification device is positioned lower than both the ventilator and the patient. Use water traps, if necessary, to limit water in the patient circuit and periodically empty these water traps. • If a heated humidifier is used, you should always monitor the temperature of the gas delivered to the patient. Gas delivered from the ventilator that becomes too hot may burn the patient's airway. • Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration. • The level of inspiratory resistance of the circuit and accessories (bacteria filter, humidifier, HMEs etc) must be as low as possible. Settings—particularly the PATIENT DISCONNECTION alarm, maximum inspired volume (Max VTI), and minimum inspired volume (Min VTI) settings—must be periodically adjusted according to changes in the patient circuit resistance—especially when filters are replaced. Adding attachments to the ventilator breathing system can cause the pressure during exhalation at the patient connection port to increase. • To ensure proper performance of the ventilator, use a patient circuit recommended by Covidien in this manual; refer to chapter 6, “Installation and Assembly” and Appendix H, “Parts and Accessories” The total specified length of the patient circuit tubing as measured from the ventilator outlet to the ventilator inlet is 1.1 metres (3.6 feet) to 2.0 metres (6.6 feet). The tubing must conform to all applicable standards and must be fitted with Ø 22 mm terminals that also conform to all applicable standards. Ensure that both the length and the internal volume of the patient circuit are appropriate for the tidal volume: a corrugated tube of Ø 22 mm for adult patients, and a corrugated tube of Ø 15 mm for pediatric patients with a tidal volume lower than 200 ml. • To ensure proper performance of the ventilator, use only accessories (including oxygen accessories) approved and recommended by Covidien. See Appendix H, “Parts and Accessories” or contact your local Covidien Sales or Service Representative. • The oxygen supply hose ages even when it is not in use and should be replaced periodically. The expiration date may be located on the back of the hose end-piece. On a DAILY basis, inspect the patient circuit to ensure that it shows no signs of damage, is properly connected, and is operating correctly without leakage. accessories should not be reused. During invasive ventilation (when an artificial airway bypasses the patient’s upper respiratory system), the patient’s upper respiratory system cannot humidify the incoming gas. For this reason, the use of a humidifier, to minimise drying of the patient’s airway and subsequent irritation and discomfort, is required. Clinician’s Manual Warnings • When using non-invasive ventilation (NIV) without an exhalation valve, use a vented nose or face mask or a non vented mask combined with a leak accessory. When using non-invasive ventilation (NIV) with an exhalation valve, use a non-vented mask. • • Before using the Nurse Call system, ensure that its connections are secure and it operates properly. • Do not use Nurse Call devices that operate based on the closure of an electrical circuit, because the devices often do not take into account possible cable disconnection or a total loss of power. Ensure that the Nurse Call device is always connected to the ventilator. • To prevent any interference with the internal sensors of the ventilator, do not install a humidifier upstream of the ventilator. • The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation. To connect the ventilator to a Nurse Call device, check the ventilator's compatibility with the Nurse Call device and order a suitable connection cable. Warnings regarding Maintenance • If a problem with the ventilator is suspected, FIRST CHECK THAT THE PATIENT IS NOT IN DANGER. If necessary, remove the patient from the ventilator and provide an alternative means of ventilation. • Never use a ventilator or any components or accessories that appear to be damaged. If any signs of damage are evident, contact your equipment supplier or Covidien. • If the ventilator is damaged or its external housing is not correctly closed or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odour, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately. • If the ventilator fails the alarm tests or if you cannot complete the tests, refer to section 5.8, “Troubleshooting” or call your equipment supplier or Covidien. • Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only personnel authorised and qualified by Covidien should repair, open or service the ventilator. • • • Regularly clean the ventilator’s Dual Bag according to manufacturer’s recommendations. • To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator. • The air inlet filter is for use on a single patient and is not reusable; do not attempt to wash, clean, or reuse it. • Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over; see chapter 10, “Routine Maintenance” This is particularly important when the ventilator is installed on a wheelchair, because environmental conditions may cause the filter to become dirty more rapidly. • Before cleaning the ventilator, first disconnect the ventilator and the patient circuit. If the ventilator is used indoors, the condition of the air inlet filter should be checked monthly. If the ventilator is used outdoors or in a dusty environment, the filter should be checked weekly and replaced as necessary. Clinician’s Manual Before cleaning the ventilator, first disconnect the ventilator and the patient circuit. The ventilator should never be immersed in any liquid, and any liquid on the surface of the device should be wiped away immediately. 1-9 Safety Information • To ensure proper servicing and avoid the possibility of physical injury to personnel or damage to the ventilator, only personnel authorised and qualified by Covidien should attempt to service or make authorised modifications to the Puritan Bennett™ 520 Ventilator. • If you cannot determine the cause of a problem with your ventilator, contact your equipment supplier. Do not use the ventilator until the problem has been corrected. • To ensure proper performance of the ventilator, the preventative maintenance schedule should be followed. For further information contact Covidien. • • On a daily basis, ensure the proper connection and operation of the patient circuit. • Use all cleaning solutions and products with caution. Read and follow the instructions associated with the cleaning solutions you use to clean your ventilator. Use only those solutions listed in Table 9-1. • Never use a liquid cleaner inside the patient circuit, or on any component of a gas pathway. Clean the patient circuit only as specified by the manufacturer's instructions. • The patient circuit is intended for single use by a single patient and should be changed according to the manufacturer’s recommendations and according to the patient circuit lifetime. Refer to the instructions for use supplied by the manufacturer of the patient circuit (included with the ventilator) and to chapter 6, “Installation and Assembly”. • A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection. • Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over (see chapter 10, “Routine Maintenance”). This is particularly important when the ventilator is installed on a wheelchair, because environmental conditions may cause the filter to become dirty more rapidly. • If the ventilator is damaged or its external housing is not correctly closed or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odour, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately. After assembling, cleaning, or reassembling the patient circuit, and on a daily basis, inspect the hoses and other components to ensure that there are no cracks or leaks and that all connections are secure. Warnings to Protect the Environment • • Batteries should be disposed of according to environmental legislation in your country and locality. For environmental protection, the ventilator and its components, whatever their respective conditions of operation, cannot be disposed of with household waste and must be submitted for suitable selective collection and possible recycling of the materials. Observe all applicable regulations when disposing of the ventilator and any of its components. Warnings regarding USB Memory Device • 1-10 Always verify the file ID before using a USB memory device to transfer data between the ventilator and a PC. Clinician’s Manual Symbols and Markings 1.3 Symbols and Markings Table 1-1. Ventilator Symbols Symbols Descriptions It is essential to read, understand, and follow these instructions before using the Puritan Bennett™ 520 Ventilator (ISO 7000-0434A). This symbol appears on the ventilator’s back panel, see Table 1-2, item 2. Type BF applied part (IEC 60417-5333). A regulatory standard classification for protection against electrical shock for the part of the device that contacts the patient. This symbol appears on the ventilator’s back panel; see Table 1-2, item 4. Direct current, DC (IEC 60417-5031). This symbol appears on the ventilator’s back panel and keyboard; see Figure 1-2 and Figure 2-3 on page 2-6, item 10. Alternating current, AC (IEC 60417-5032). This symbol appears on the ventilator’s back panel and keyboard; see Figure 1-2, item 6, and Figure 2-3 on page 2-6, item 10. Internal Battery. This symbol appears on the ventilator’s keyboard; see Figure 2-3 on page 2-6, item 10. Insulation class II equipment (IEC 60417-5172). A regulatory standard classification for protection against electric shock. Class II equipment relies on double insulation rather than protective earthing. This symbol appears on the ventilator’s back panel; see Table 1-2, item 4. Index of Protection rating for the ventilator’s enclosure, defined in IEC 60529 (BSEN60529:1991). IP31 The first digit, 3, indicates protection against the intrusion of small foreign bodies (including fingers, tools, wires, etc. with a diameter greater than 2.5 mm) into the ventilator. The second digit, 1, indicates protection against water dripping or falling vertically, as well as an environment featuring water vapour condensation and/or light rain. This rating appears on the ventilator’s back panel; see Table 1-2, item 4. CSA – Canadian Standards Association. This symbol appears on the ventilator’s back panel; see Table 1-2, item 4. CE - Conformity European Signifies compliance with the medical device directive 2007/47/EC. This symbol appears on the ventilator’s back panel; see Table 1-2, item 4. This symbol appears on the ventilator’s front panel UP key; see Figure 2-3 on page 2-6, item 4. This key is used to: move the LCD display’s cursor upwards, line-by-line; increase the value of displayed and selected parameter setting. This symbol appears on the ventilator’s front panel DOWN key; see Figure 2-3 on page 2-6, item 6. This key is used to: move the LCD display’s cursor downwards, line-by-line; decrease the value of displayed and selected parameter settings. This symbol appears on the ventilator’s front panel ENTER key; see Figure 2-3 on page 2-6, item 5. This key is used to confirm command actions. Clinician’s Manual 1-11 Safety Information Table 1-1. Ventilator Symbols Symbols Descriptions This symbol appears on the ventilator’s front panel ALARM CONTROL key; see Figure 2-3 on page 2-6, item 2. (See my notes, to the left and below, in red). This key is used to: cancel the audible portion of alarms for 60 seconds at a time; cancel an alarm. For more information, refer to Appendix F, “Alarms Tests” This symbol appears on the ventilator’s front panel MENU key; see Figure 2-3 on page 2-6, item 7. This key is used to access the ventilator’s menus via the ventilator’s front panel LCD display. This symbol (IEC 60417– 5009) appears on the ventilator’s front panel VENTILATION ON/OFF button; see Figure 2-3 on page 2-6, item 8. This key is used to Start and Stop ventilation. To patient port. This symbol appears on the front right of the ventilator, adjacent to the To Patient port; see Figure 1-1 on page 1-16, item 1. Patient proximal pressure port. This symbol appears on the front right of the ventilator, adjacent to the To Patient port; see Figure 1-1 on page 1-16, item 3 and Figure 1-3 on page 1-17. Exhalation valve pilot port. This symbol appears on the front right of the ventilator, adjacent to the To Patient port indicating the connection of the tubing between the patient circuit exhalation valve; see Figure 1-1 on page 1-16, and Figure 1-3 on page 1-17, item 3. Oxygen inlet. This marking appears on the back panel of the ventilator, adjacent to the oxygen inlet port; see Figure 1-2 on page 1-16, item 2. Nurse Call connector. This symbol appears on the back panel of the ventilator, adjacent to the nurse call connector; see Figure 1-2 on page 1-16, item 10. Switch in “Off” position (IEC 60417-5008). O This symbol appears on the I/O (power on/off ) switch on the back panel of the ventilator to indicate the switch’s “Off” position. See Figure 2-2 on page 2-5, item 2. Switch in “On” position (IEC 60417-5007). I This symbol appears on the I/O (power on/off ) switch on the back panel of the ventilator to indicate the switch’s “On” position. See Figure 2-2 on page 2-5, item 2. Software Lock Enabled. This symbol appears on the upper-left of the ventilator’s LCD display when the keyboard Locking Key is enabled; see 7.8, “Locking the Control Panel”. Internal Battery. This symbol appears on the top-center of ventilator’s LCD display to indicate that the ventilator is being powered by its internal battery. See Figure 2-4 on page 2-7, item 1 and refer to chapter 8, “Internal Battery”, for more information. Pressure rise times (inspiratory phase) parameter. These symbols appear on the ventilation mode menu screens. For more information, refer to chapter 3, “Operating Parameters”. In pressure ventilation modes, you can select one of four rise times with setting 1 representing the fastest rise time and setting 4 representing the slowest. Selected line (filled square). When making menu choices, this graphic indicates the line on which the cursor is currently positioned. see Figure 7-11, Selecting the Preferences Menu, on page 7-9. 1-12 Clinician’s Manual Symbols and Markings Table 1-1. Ventilator Symbols Symbols Descriptions Non-selected line (empty square). When making menu choices, this graphic indicates a line on which the cursor is currently not positioned. Locked parameter line. When making menu choices, this graphic indicates a line that cannot be selected (the Locking Key is enabled). Active parameter line. When making menu choices, this graphic indicates that the current parameter is selected and can be changed. See chapter 7, “Operating Procedures”. Inspiratory Effort Detected. This symbol appears in the front panel display’s Status window when the patient triggers a breath. Parameter adjustment bar. This graphic shows the current setting for parameters such as display contrast and alarm volume in the Preferences menu. Refer to 7.3, “Preferences Menu Parameters”. WEEE (Waste Electrical and Electronic Equipment). This symbol means that this product must not be disposed of with household waste. Observe local ordinances for proper disposal. Refer to Table 1-2, item 4. Year of Manufacture. Manufacturer. Audio Paused. This symbol means the sounding of audible alarms is currently disabled. For more information, refer to 5.4, “Silencing the Audible Portion of Alarms”. Alarm Paused (reset/cancelled). This symbol means one or more alarms have been paused, or reset/cancelled. For more information, refer to 5.5, “Pausing/Resetting Alarms”. Apnea Alarm Deactivated. This symbol means that the Apnea Alarm has been deactivated. For more information, refer to 5.5, “Pausing/Resetting Alarms”. Exhalation Valve detected. This symbol means that an exhalation valve has been detected during ventilation. No Exhalation Valve detected. This symbol means that no exhalation valve has been detected during ventilation. Follow instructions for use (ISO 7000-1641). This symbol directs the user to observe and adhere to the instructions contained in the product’s user manuals. USB port. This symbol indicates a communications port for interfacing with a USB connector. See Figure 1-2, item 9. Clinician’s Manual 1-13 Safety Information Table 1-1. Ventilator Symbols Symbols Descriptions PC connector. This symbol indicates a port that can be used by authorised Puritan Bennett product service personnel or Covidien service personnel for software maintenance. See Figure 1-2, item 8. Atmospheric pressure limitation. Humidity limitations. Temperature limitations. Fragile. Keep dry. Keep away from direct sunlight. This side up. 1.4 Labels / Identification and Instruction Information Various labels or specific markings are affixed to the ventilator that describe precautions to be taken for the correct use of the ventilator and contribute to the traceability of the product. Refer to Table 1-2 and the figures on the following pages for illustrations of these labels and markings and their locations on the ventilator. Use the item numbers in the following tables to locate the labels in Figure 1-1 to Figure 1-3. Table 1-2. Ventilator Labels and Markings 1. Patient Gas Inlet Label (Figure 1-1, Figure 1-3) 1-14 2. Oxygen Inlet Marking and Label (Figure 1-2) 3. Exhalation Valve and Patient Pressure Connection Label (Figure 1-1, Figure 1-3) Clinician’s Manual Labels / Identification and Instruction Information Table 1-2. Ventilator Labels and Markings (Continued) Location of AC Power Cable Connector 4. Air Inlet Label (Figure 1-2) 5. Identification Label (Figure 1-3) 6. AC Power (Mains) Cable Connector Marking (Figure 1-2) 8. PC Connection marking (Figure 1-2) 9. USB Port marking (Figure 1-2) N/A N/A Location of DC Power Cable Connector 7. External Cable Connector Marking (Figure 1-2) 10. Nurse Call Cable Connector Marking (Figure 1-2) Note: The item number callouts in the following figures refer to those listed in Table 1-2. Clinician’s Manual 1-15 Safety Information Figure 1-1. Locations of Labels – Top-Front View 9 8 7 6 4 10 2 2 Figure 1-2. Location of Labels and Markings – Rear View 1-16 Clinician’s Manual Labels / Identification and Instruction Information 3 1 7 Figure 1-3. Location of Labels – Bottom View Clinician’s Manual 1-17 Safety Information This page intentionally blank 1-18 Clinician’s Manual Indications for Use 2 Ventilator Overview 2.1 Indications for Use The Puritan Bennett™ 520 Ventilator is indicated for the continuous or intermittent mechanical ventilatory support of patients weighing at least 11 lb (5 kg) who require mechanical ventilation. The ventilator is a restricted medical device intended for use by qualified, trained personnel under the direction of a doctor. It is essential to read, understand, and follow these instructions before using the Puritan Bennett™ 520 Ventilator. Target Patients Specifically, the ventilator is applicable for adult and pediatric patients who require the following general types of invasive or non-invasive ventilatory support, as prescribed by an attending doctor: • Positive Pressure ventilation • Assist/Control, PSV or CPAP modes of ventilation • Breath types including Pressure Control and Pressure Support Target Environments The ventilator is suitable for use in institutional, home, and portable settings. It is not intended for use as an emergency transport ventilator. The Puritan Bennett™ 520 Ventilator is suitable for use on commercial aircraft, per FAA requirements. Refer to section B.11, “Standards Compliance and IEC Classification”. Patients travelling with the Puritan Bennett™ 520 Ventilator may be required by their airline to demonstrate evidence of compliance with the RTCA/DO-160F standard, as well as other requirements. Contact your airline prior to travel to determine airline specific requirements and documentation. WARNING Even though the Puritan Bennett™ 520 Ventilator meets current safety standards, and although the internal Lithium-ion battery of the device is considered to be Dangerous Goods for transport in commerce, this devices lithium battery is below the 100Wh threshold and is therefore excepted from being a Class 9 – Miscellaneous - Dangerous Goods (DG) . As such, the Puritan Bennett™ 520 Ventilator and/or the associated Lithium-ion battery are subject tosome transport conditions under the Dangerous Goods Regulation for air transport (IATA: International Air Transport Association), International Maritime Dangerous Goods code for sea and the European Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) for Europe. Private individuals who transport the device are excluded from these regulations although for air transport some requirements apply. For air transport; the Puritan Bennett™ 520 Ventilator is permitted as checked-in or carry-on baggage. Spare batteries may be taken on board as carry-on luggage only. This classification and regulatory requirements may vary depending upon the country and mode of transport. Therefore it is recommended that users verify with the carrier / airline as to which measures to take before the voyage. Target Operators The ventilator may be operated by: • Respiratory therapists • Doctors • Nurses Clinician’s Manual 2-1 Ventilator Overview • Homecare providers • Patient and patient’s families For more details on the knowledge and skill requirements for operating the Puritan Bennett™ 520 Ventilator, refer to Appendix A, "Patient/Caregiver Checklist". WARNING This ventilator must be used only under the responsibility and on the prescription of a doctor. The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent. 2.2 Contraindications This ventilator is not for use with anesthetic gases, and is not intended for use as an emergency transport ventilator. It is not intended to be used for patients without breathing autonomy or who are ventilator dependent. 2.3 Operational Use The Puritan Bennett™ 520 Portable Ventilator uses a micro-turbine to provide ventilatory support to patients. Clinicians may use a variety of interfaces to connect patients to the ventilator: nasal masks or full face masks; endotracheal or tracheotomy tubes. User-selectable ventilation modes are: • Assisted Controlled Pressure (P A/C) • Continuous Positive Airway Pressure (CPAP) • Pressure Support Ventilation with apnea ventilation (PSV/ST) Safety Net Incorporated in the ventilator design is an alarm system that continuously monitors both patient and machine for signs of specific errors or faults that could lead to an unsafe condition. Should any of these errors or faults be detected, the alarm system announces the specific alarm condition both audibly and visually. The machine-related alarm conditions are factory set, whereas the patientrelated alarm conditions are defined by alarm-threshold values selected by an operator (a clinician or a caregiver). For more information, refer to chapter 5, “Alarms and Troubleshooting.” WARNING Patients on home care ventilation equipment should be appropriately monitored by clinicians, caregivers and suitable monitoring equipment, as advised by the patient’s clinician. The Puritan Bennett™ 520 Ventilator is not intended to be a comprehensive monitoring device and does not activate alarms for all types of dangerous conditions for patients. Settings A software key, known as the “Locking Key,” restricts access to ventilation parameter settings and ventilation mode changes in order to distinguish between “clinician” usage and “patient” usage (refer to section 7.8, “Locking the Control Panel,” on page 7-27). Oxygen Enrichment Oxygen may be supplied from an external, low pressure source, but the oxygen flow must be limited to 15 lpm (50 kPa, 7 PSI). The ventilator automatically compensates for the extra flow created by the external oxygen supply (refer to chapter 6, “Installation and Assembly.” 2-2 Clinician’s Manual Device Classification WARNING To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses. Oxygen therapy for patients with respiratory failure is a common and effective medical prescription. However, be aware that inappropriate oxygen use may potentially lead to serious complications, including, but not limited to, patient injury. Users must always possess an additional breathing circuit and exhalation valve while using the Puritan Bennett™ 520 Ventilator. Breathing Circuit The ventilator is used with a single limb patient circuit. For more information, refer to section 6.4, “Patient Circuit,” on page 6-6. 2.4 Device Classification The ventilator’s IEC / EN 60601-1 classification is as follows: • • • • • • Protection/Insulation class (electric shock): Class II Protection index of enclosure: IP31 Medical device directive classification: II B Degree of protection against risk of electric shock: BF Power: External (AC – mains, or DC – cigarette lighter) or internal (DC – battery) Operation mode: Continuous operation For additional information, refer to Appendix B, “Specifications.” Clinician’s Manual 2-3 Ventilator Overview 2.5 Front Panel 1 2 6 6 3 6 5 4 1 LCD Display – Displays information about the ventilator including patient hours and software version, ventilation modes and settings, and monitored and calculated patient data. The display also allows the user to view and, using the Control Panel, adjust the ventilator’s operating and alarm configuration settings. 4 Patient Pressure Monitoring Port – Nipple for monitoring proximal patient pressure. 2 Control Panel – Features the controls for setting up and operating the ventilator, and LEDs to indicate the ventilator's power source, ventilation On/Off status, and alarm priority level. Control functions include turning on and off the ventilation, configuring ventilation modes, silencing and cancelling alarms, and setting device and alarm parameters. 5 Exhalation Valve Port – Nipple for providing piloting pressure to the exhalation valve. Controls the open-closed position of the exhalation valve. 3 Patient Connection Port – Provides an outlet for the gas to be delivered to the patient via the patient circuit. 6 Lateral and Front Openings – Vents that allow for air circulation to cool the ventilator’s internal components. In addition, these openings function as sound ports for audible alarms. WARNING Do not cover or obstruct these openings. Figure 2-1. Front Panel 2-4 Clinician’s Manual Back Panel 2.6 Back Panel 1 2 3 11 4 10 9 8 7 6 5 1 Ergonomic carrying handle. 7 PC Cable Connector: USB mini-B connector used for Puritan Bennett™ Ventilator Test Software. 2 On/Off (I/O) switch with protective cover: Device powered on in position I; device switched off in position 0. 8 O2 Inlet Port: Connects the ventilator to a low pressure oxygen source via an adaptor connected to the O2 Inlet (refer to section 6.7.1 , “Administering Oxygen,” on page 6-12). 3 AC power (“Mains”) cable connector. 9 Nurse Call Output Connector: Used to connect the ventilator to the nurse call system. 4 AC power (“Mains”) cable holding system: Secures AC power cable to avoid accidental disconnection. 10 USB Memory Device connection: USB connection to be used with Puritan Bennett™ Respiratory Insight Software. There are two USB type A ports. 5 Access cover for the internal battery. 11 Air Inlet Filter: Filters air as it enters the ventilator. 6 DC power cable connector with key. WARNING Do not cover or obstruct these openings. Figure 2-2. Back Panel Clinician’s Manual 2-5 Ventilator Overview 2.7 Control Panel 1 2 10 3 9 4 8 5 7 6 1 Alarm indicators (two LEDs): 6 DOWN key: • Red indicator: Moves the cursor down and decreases parameter values. • Continuous: Very High Priority (VHP) alarm activated • High priority (HP) alarm activated. Yellow indicator: • Medium priority (MP) alarm activated. 2 ALARM CONTROL key: • • 7 3 Display screen: When a USB memory device is inserted into the ventilator, press this key to display the USB memory device screen. 8 • Moves the cursor up and increases parameter values. VENTILATION ON/OFF button: • • Display of modes, ventilation settings, patient data, configuration of the ventilator and alarm management. 4 UP Key: MENU key: Changes the displayed menu. From the Ventilation menu screen, press this key to display the Alarm menu screen. Press once to silence an audible alarm for 60 seconds. Press twice to halt visual and audible alarms. If alarm is remedied, the alarm is cancelled (other than the high pressure alarm). 9 Ventilation status indicator: • • 5 ENTER key: • • Access to a setting value and validation of the modification of this setting. Access to a sub-menu. ON: Press briefly and release to start ventilation. OFF: Press and hold for three (3) seconds, then press again to stop ventilation. Blue indicator illuminated: device is powered on and ventilation is off (on standby). Blue indicator off: ventilation is on. 10 Electrical power source indicators: • • • • AC POWER indicator lit: AC power source connected. DC POWER indicator lit: DC power source connected. INTERNAL BATTERY indicator lit continuously: Internal battery in use (no external power source connected.) INTERNAL BATTERY indicator flashing: battery charging. Figure 2-3. Control Panel 2-6 Clinician’s Manual Ventilation Menu 2.8 Ventilation Menu 1 Ventilation menu with ventilation on standby. 2 5 3 6 4 1 Ventilation menu during ventilation. 2 5 6 3 4 1 General information line: 2 Displays the current ventilation mode, along with the following: • • • • • • • • Displays pressure generation during ventilation. 3 Displays the specific ventilation parameter values for the currently selected ventilation mode. Battery symbol if the device is powered by the internal battery. Audio paused symbol if an alarm is currently inhibited. Alarm paused symbol if an alarm has been cancelled manually and the cause of the alarm remains. Apnea Alarm deactivation Exhalation valve symbol. No exhalation valve symbol. Absolute ABS symbol. Relative REL symbol. 4 Bargraph: Ventilation settings: Highlight this line and press the ENTER key to display the Preferences menu. Refer to manual section 7.3, “Preferences Menu Parameters,” on page 7-9 for more information. Refer to chapter 3, “Operating Parameters” for more information. 5 Status/monitored data window: • • • Ventilation stopped (Standby): displays the message, “PRESS TO START VENTILATION.” Ventilation on: parameters are monitored and displayed. The Inspiratory Effort Detected symbol appears adjacent to the monitored I:E ratio when the patient actively triggers a breath. Preferences menu access line: 6 Alarm conditions window: • For Active alarms, scrolls through active alarm messages in flashing reverse video. • For Inactive alarms, displays the last alarm along with its trigger date and end-of-event time. Refer to chapter 5, “Alarms and Troubleshooting” for details. Figure 2-4. Ventilation Menu Display Clinician’s Manual 2-7 Ventilator Overview 2.9 Alarm Menu 1 4 Alarm menu with ventilation on standby. 2 5 3 1 4 Alarm menu when not in standby. 2 5 3 1 Title line: Displays ventilation mode and the following symbols: • • • • • • Battery if the ventilator is powered by the internal battery. Audio paused if an alarm is currently inhibited. Alarm paused if an alarm has been cancelled manually and the cause of the alarm remains. Apnea Alarm deactivation Exhalation valve symbol. No exhalation valve symbol. 4 Status/monitored data window: • • • Ventilation stopped (Standby): displays the message, “PRESS TO START VENTILATION.” Ventilation on: parameters are monitored and displayed. The Inspiratory Effort Detected appears adjacent to the symbol monitored I:E ratio when the patient actively triggers a breath. 2 Alarm settings: Displays the specific alarm parameter values for the currently selected ventilation mode, which are: • • Min and Max alarm threshold settings, and Current monitored patient readings, or hyphen (-) when ventilation is in standby. 3 Access line to Alarm Log menu. Highlight this line and press the ENTER key to display the Alarm Logs menu. Refer to manual section 5.3, “Alarm Log Menu,” on page 5-3. 5 Alarm message window: • For Active alarms, scrolls through active alarm messages in flashing reverse video. • For Inactive alarms, displays the last alarm along with its trigger date and end-of-event time. Refer to chapter 5, “Alarms and Troubleshooting” for more information. Figure 2-5. Alarm Menu 2-8 Clinician’s Manual USB Memory Device Menu 2.10 USB Memory Device Menu 1 2 3 4 1 Title line 3 USB Memory Device Menu 2 Ventilator serial number 4 Dialogue box Figure 2-6. USB Memory Device Menu 2.11 If Ventilator Failure Occurs If a problem with the ventilator is suspected, FIRST CHECK THAT THE PATIENT IS NOT IN DANGER. If necessary, remove the patient from the ventilator and provide an alternate means of ventilation. Keep in mind that troubleshooting information is available in this manual to assist you in the event of a problem. Refer to chapter 5, “Alarms and Troubleshooting”. If you cannot determine the cause of a problem, contact your equipment supplier or Covidien. Refer to Appendix 10.3, “Service Assistance”. Clinician’s Manual 2-9 Ventilator Overview This page intentionally blank 2-10 Clinician’s Manual PSV Mode Parameters and Setting Ranges 3 Operating Parameters This chapter describes ventilation and alarm parameters and their setting ranges for each ventilation mode. For a listing of operating parameters and monitored patient data, refer to Table B-8 on page B-3. For further information about the different ventilation modes and breath types provided by the Puritan Bennett™ 520 Ventilator, refer to Appendix D, “Modes and Breath Types.” WARNING The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent. If APNEA TIME is set to a value higher than 60/Rate then the APNEA alarm will not activate. Note: Before choosing settings for operating parameters and alarms, be sure to carefully review the Warnings Regarding Settings. See section 1.2, “Warnings,” on page 1-1. 3.1 PSV Mode Parameters and Setting Ranges The menus for PSV - Pressure Support Ventilation mode are shown in Figure 3-1, and Figure 3-2: Figure 3-1. Menus in PSV Mode with Exhalation Valve Configuration Clinician’s Manual 3-1 Operating Parameters Figure 3-2. Menus in PSV Mode with Leakage Configuration The ventilation parameters and setting ranges available in PSV mode are listed in Table 3-1. Table 3-1. Ventilation Parameters in PSV Menu Name Units P Support cmH2O, mbar or hPa Max. Value Min. Value Adjustment Resolution Default Value Linked Parameters 1 15 PEEP 1 OFF P Support Standby: 55 Standby: 2 Valve configuration: 5 Valve configuration: 55 Leak configuration: 6 Standby: OFF Leak configuration: 30 cmH2O, m bar or hPa Valve configuration:OFF Rise Time – 1 4 1 2 Insp Time I Sens – 1P 5 1 2 – E Sensa % 5 (-95) 95 (-5) 5 Auto – Backup R bpm 4 40 1 13 Min I Time Apnea Time s 1 60 1 Auto Backup R Vt Target ml 50 2000 10 OFF = 100 – Min I Time s 0.1 2.8 0.1 Auto Max I Time Max P mbar 8 55 1 PIP + 3 - Max I Time s 0.8 3 0.1 Auto Min I Time PEEP 20 Max P Leak configuration: 4 a. Refer to chapter 7, “Operating Procedures” for information on positive and negative E Sens settings Table 3-2 lists the available alarm settings in PSV mode. Table 3-2. Alarm Parameters in PSV Mode 3-2 Name Units Min. Value Max. Value Adjustment Resolution Default Value Linked Parameters Min VTI ml 30 2000 10 300 Max VTI Max VTI ml 80 3000 10 2,000 Min VTI Max Leak (with leak configuration) lpm 5 200 5 OFF - Max Rtot bpm 10 70 1 OFF Backup R Clinician’s Manual PSV Mode Parameters and Setting Ranges P Support - Pressure Support When Relative Pressure is set to YES in the Setup Menu, P Support allows you to determine inspiratory pressure added to PEEP during the inspiratory phase. In this configuration, the sum of P Support and PEEP must not exceed 55 mbar. When Relative Pressure is set to OFF in the Setup Menu, P Support allows you to determine inspiratory Absolute pressure. In this configuration, P Support and PEEP are related and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration. PEEP – Positive End Expiratory Pressure PEEP allows you to determine the level of pressure maintained during the exhalation phase. When Relative Pressure is set to YES in the Setup Menu, the sum of P Support and PEEP must not exceed 55 mbar. When relative pressure is set to OFF, P Support and PEEP are related and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration. The ventilation mode can be adjusted without PEEP (PEEP is nearly 0 mbar when set to “OFF”) in valve configuration. In leak configuration, the minimum PEEP setting is 4 mbar. Rise Time This parameter is used during the inspiration phase to determine how the target pressure will be reached. This setting indirectly defines the minimum inspiratory time. The different levels available are as follows: Rise time = 200 ms Rise time = 400 ms Rise time = 600 ms Rise time = 800 ms These time ranges are determined by the pressure setting required, the breath rate, and the physiological condition of the patient. I Sens – Inspiratory Trigger Sensitivity I Sens allows you to set the level of inspiratory effort the patient has to provide during the initiation of a machine breath. The sensitivity levels decrease from 1P to 5: the lower the number, the more sensitive the trigger sensitivity. These levels correspond to differences in flow compared to the bias flow. I Sens 1 (P) = Bias flow + (0.4 lpm to 1 lpm) (P = Pediatric use) I Sens 2 = Bias flow + (0.7 lpm to 1.3 lpm) I Sens 3 = Bias flow + (0.9 lpm to 1.5 lpm) I Sens 4 = Bias flow + (1.0 lpm to 1.6 lpm) I Sens 5 = Bias flow + (1.2 lpm to 1.8 lpm) The bias flow consists of turbine flow through the patient circuit, during the exhalation phase, that helps the patient avoid rebreathing exhaled gas (CO2). Clinician’s Manual 3-3 Operating Parameters The inspiratory trigger is initiated after a time delay of between 700 ms to 1500 ms, depending on the preceding peak inspiratory flow. WARNING Ensure that the I Sens setting is not set to OFF when ventilating patients capable of triggering spontaneous breaths. Carefully modify the trigger threshold setting to reduce the risk of ventilator autotriggering. Level 1P, the most sensitive inspiratory trigger, is recommended for pediatric use. For an adult, this setting may result in ventilator autotriggering. E Sens – EXHALATION SENSITIVITY E sens is available in PSV mode. E Sens allows you to determine sensitivity of switching to exhalation and thus indirectly determines the inspiratory time of a breath. The end of inspiration will occur when Inspiratory Flow has decreased to the preset E Sens setting. The exhalation trigger is only taken into account after the Rise Time (which constitutes a default minimum inspiratory time) has elapsed. If the flow drop is insufficient, exhalation is automatically triggered independently of the E Sens, which is defined as a percentage of peak inspiratory flow. Exhalation may be triggered if the maximum inspiratory time of three (3) seconds has elapsed, which corresponds to an I:E Ratio of 1:1.0, to ensure that the patient has enough time to exhale. Insp Sec Exh Figure 3-3. Exhalation Trigger Sensitivity Note: (Refer to section 7.2.2 , “Changing the Setup Menu Parameters” for positive and negative E Sens settings.) Backup R Backup R allows you to determine the frequency of ventilation breaths to be applied in the event of prolonged apnea—as long as no inspiratory trigger is detected. The inspiratory time of the backup breaths applied in the event of apnea still depends on the detection of Exhalation trigger (E Sens) and the safety maximum inspiratory time (see above comment on E Sens). The rise time of these cycles is identical to the ventilation cycle previously set. The controlled cycles following apnea are interrupted as soon as a new spontaneous inspiration of the patient is detected. The Backup R is linked to the Min I Time so that the Min I Time setting cannot be greater than half the inspiratory phase of a ventilator controlled breath. 3-4 Clinician’s Manual PSV Mode Parameters and Setting Ranges Backup R breath is delivered at the Pressure Support settings. Setting a Backup Rate is not optional; it is always set. Apnea Time Apnea time allows the user to monitor and detect interruptions to the patient's spontaneous breathing pattern. The ventilator declares apnea when no breath has been delivered by the time that the operator-selected apnea interval elapses. The APNEA TIME adjustment range shall be 1 to 60 seconds. The ventilator shall enable the operator to set an auto-setting which shall automatically calculate the APNEA TIME according to the following: APNEA TIME = 60 / BACKUP R for PSV ST mode. The Apnea Time “AUTO” setting (in seconds) is calculated using the formula (Auto = Maximum value between 3 seconds and 60/Backup R or AUTO=30 in CPAP mode). Note: During apnea ventilation, the ventilator delivers machine controlled breaths according to a backup rate (Backup R)—as long as no inspiratory trigger has been detected. The Backup R value applied depends on the Rate setting. If the Apnea Alarm is set to OFF in the Preferences Menu, the Apnea Time setting will still be active. VT Target - TARGET TIDAL VOLUME VT Target allows the ventilator to deliver a target volume of gas to the patient. When a VT Target is set, the ventilator constantly adjusts the target inspiratory pressure between PIP and Max P to ensure the inspired tidal volume remains as close as possible to the VT target. VT Target should be more than 10 ml lower than Max VTI to avoid triggering VTI alarm. The minimum increase or decrease of target inspiratory pressure is 0.5 mbar and the maximum is 2 mbar. Setting the Vt Target is not mandatory (it can be set to “OFF”). Max P - MAXIMUM INSPIRATION PRESSURE Max P allows the ventilator to adjust the inspiratory pressure up to a maximum limit in order to reach the Target Tidal Volume. (Vt Target) P Support and Max P are related and the difference between them must be less than 20 mbar. Max P is not displayed when VT Target is set to OFF. Min and Max I Time – MINIMUM / MAXIMUM INSPIRATION TIME Min I Time and Max I Time are ventilation parameters that can be adjusted in the alarm menu. Min I Time defines the minimum duration of time the inspiratory phase is maintained. It takes priority over activation of the exhalation trigger which can only be triggered after the Min I Time has expired. The Backup R is linked to the Min I Time so that the Min I Time setting cannot be greater than half the inspiratory phase of a cycle triggered by the ventilator. If Backup R is changed, Min I Time is, if necessary, automatically readjusted so that the difference between them is always maintained. The minimum time by default if no parameter is set (Min I Time = AUTO) corresponds to the lower value in the range of the Rise Time to which an operating margin of 0.3 seconds is added. See “Rise Time” on page 3-3 for details about Rise Time. Max I Time defines the maximum duration of time during which the inspiratory phase is maintained. The switch-over to exhalation occurs, at the latest, after this time has expired. Clinician’s Manual 3-5 Operating Parameters By default, if no parameter is set, the maximum time (Max I Time = AUTO) is the shortest time between a fixed time of three (3) seconds and half the duration of the patient’s inspiratory breaths expressed in seconds. (AUTO equals the lesser of 3 seconds or 30/Rate). This default value will be applied if it is lower than the Max I Time setting. Min I Time and Max I Time are related so that the Max I Time cannot be set to a value lower than the Min I Time. VTI (Min and/or Max Alarm Settings) – INSPIRATORY TIDAL VOLUME It is possible to set a minimum and/or maximum Tidal Volume alarm threshold for the patient’s inspired tidal volume during a cycle. This setting is used to trigger an alarm if the Tidal volume inspired by the patient is lower than the minimum threshold set (“LOW VTI” alarm) or greater than the maximum threshold set (“HIGH VTI” alarm). Refer to chapter 5, “Alarms and Troubleshooting”. Min VTI and Max VTI are related, and their settings must be set to values that maintain a minimum difference of 20 ml between the two. It is not mandatory to set the minimum and maximum VTI alarm limits. When the minimum and maximum VTI alarm limits are not set, the display will read “OFF” for these settings. Max Leak (Max Alarm Settings) The setting of a high leakage threshold enables a “HIGH LEAKAGE” alarm to be triggered in the event the calculated leakage flow exceeds this limit. The displayed value corresponds to the mean parasite leakage flow observed during the exhalation phase. Max Leak is displayed when ventilating without an exhalation valve. Setting the Max Leak is not mandatory (it can be set to “OFF”), but the measured value is always displayed. Max Rtot (Max Alarm Setting) – TOTAL BREATH RATE The maximum rate threshold set is used to warn of hyperventilation or ventilator autotriggering. The alarm setting is used to trigger the “HIGH RATE” alarm. Refer to chapter 5, “Alarms and Troubleshooting”. When set, the Max Rtot threshold must always exceed the Backup Rate by 5 bpm. If the Backup Rate is readjusted, the Max Rtot is automatically readjusted to maintain a minimum difference of 5 bpm. Setting the Max Rtot is not mandatory (it can be set to “OFF”), but the measured value is always displayed. 3.2 CPAP Mode Parameters and Setting Ranges The menus in CPAP (Continuous Positive Airway Pressure) ventilation mode are shown in Figure 3-4: 3-6 Clinician’s Manual CPAP Mode Parameters and Setting Ranges Figure 3-4. Menus in CPAP Mode in Leakage Configuration The ventilation parameters and setting ranges available in CPAP mode are listed in Table 3-3. Table 3-3. Ventilation Parameters in CPAP Menu Name Units Min. Value Max. Value Adjustment Resolution Default Value Linked Parameters PEEP cmH2O, mbar or hPa 4 20 1 10 PIP Apnea Timea s 1 60 1 Auto Backup R a. not available if Apnea Alarm is set to OFF in Preferences Menu Table 3-4 lists the available alarm settings in CPAP mode. Table 3-4. Alarm Parameters in CPAP Mode Name Units Min. Value Max. Value Adjustment Resolution Default Value Linked Parameters Min VTI ml 30 2,000 10 300 Max VTI Max VTI ml 80 3,000 10 2,000 Min VTI Max Leak lpm 5 200 5 OFF - Max Rtot bpm 10 70 1 OFF Backup R WARNING The CPAP mode does not provide a set respiratory rate. Do not use this mode if it is not appropriate for the patient’s condition. Note: Only leak configuration is available in CPAP mode. PEEP – Positive End Expiratory Pressure PEEP allows you to determine the level of pressure maintained during the exhalation phase. The ventilation mode can be adjusted without PEEP (PEEP is nearly 0 mbar when set to “OFF”). A PEEP value can be set to determine the level of pressure maintained during the inspiratory phase and the exhalation phase. Clinician’s Manual 3-7 Operating Parameters Apnea Time Apnea time allows the user to monitor and detect interruptions to the patient's spontaneous breathing pattern. The ventilator declares apnea when no breath has been delivered by the time that the operator-selected apnea interval elapses. The Apnea Time “AUTO” setting is 30 seconds. Apnea Time is not available if Apnea Alarm is set to OFF in the Preferences Menu. VTI (Min and/or Max Alarm Settings) – INSPIRATORY TIDAL VOLUME It is possible to set a Min and/or Max Tidal Volume alarm threshold for the patient’s inspired tidal volume during a cycle. This setting is used to trigger an alarm if the Tidal volume inspired by the patient is lower than the minimum threshold set (“LOW VTI” alarm) or greater than the maximum threshold set (“HIGH VTI” alarm). Refer to chapter 5, “Alarms and Troubleshooting”. Min VTI and Max VTI are related, and their settings must be set to values that maintain a minimum difference of 20 ml between the two. It is not mandatory to set the minimum and maximum VTI alarm limits. When the minimum and maximum VTI alarm limits are not set, the display will read “OFF” for these settings. Max Leak (Max Alarm Settings) The setting of a high leakage threshold enables a “HIGH LEAKAGE” alarm to be triggered in the event the calculated leakage flow exceeds this limit. The displayed value corresponds to the mean parasite leakage flow observed during the exhalation phase. It is not mandatory to set the minimum and maximum LEAK alarm limits. When the minimum and maximum LEAK alarm limits are not set, the display will read “OFF” for these settings. Max Rtot (Max Alarm Setting) – TOTAL BREATH RATE The maximum rate threshold set is used to warn of hyperventilation or ventilator autotriggering. The alarm setting is used to trigger the “HIGH RATE” alarm. Refer to chapter 5, “Alarms and Troubleshooting”. When set, the Max Rtot threshold must always exceed the Backup Rate by 5 bpm. If the Backup Rate is readjusted, the Max Rtot is automatically readjusted to maintain a minimum difference of 5 bpm. Setting the Max Rtot is not mandatory (it can be set to “OFF”), but the measured value is always displayed. I Sens - INSPIRATORY TRIGGER SENSITIVITY The trigger threshold for switching to inhalation cannot be set in CPAP mode. The device is configured with a default I Sens of 2. E Sens - EXHALATION TRIGGER SENSITIVITY The trigger threshold for switching to exhalation cannot be set in CPAP mode. The device is configured with a default E Sens of 25%. 3.3 P A/C Mode Parameters and Setting Ranges The menus in P A/C (Pressure Assisted/Controlled) ventilation mode are shown in Figure 3-5 and Figure 3-6. 3-8 Clinician’s Manual P A/C Mode Parameters and Setting Ranges Figure 3-5. Menus in P A/C Mode with Exhalation Valve Configuration Figure 3-6. Menus in P A/C Mode with Leakage Configuration The Ventilation parameters adjustable in P A/C mode are listed in Table 3-5. Table 3-5. Ventilation Parameters in P A/C Mode Menu Default Value Linked Parameters 1 15 PEEP 20 1 OFF PIP 1 4 1 2 5 60 1 13 1/4 1/1 1/0.1 1/2 (20%) (50%) (1%) (33%) OFF 5 1 2 Units PIP cmH2O, mbar or hPa Valve configuration: 5 Valve configuration:55 Leak configuration: 30 cmH2O, mbar or hPa Leak configuration: 6 Standby: OFF Valve configuration:OFF Rise Time – Rate bpm PEEP I:E/ (I/T) I Sens Clinician’s Manual s – Min. Value Max. Adjustment Value Resolution Standby: 55 Name Standby: 2 Leak configuration: 4 Rate I/T Max Rtot Vt – – 3-9 Operating Parameters Table 3-5. Ventilation Parameters in P A/C Mode Menu VT Target ml 50 2000 10 OFF Max P cmH2O, mbar or hPa 8 55 1 PIP + 3 Min VTI Max VTI PIP PEEP Table 3-6 lists the adjustable alarm parameters in P A/C mode. Table 3-6. Alarm Parameters in P A/C Mode Name Units Min. Value Max. Value Adjustment Resolution Default Value Linked Parameters Min VTI ml 30 2,000 10 300 Max VTI Max VTI ml 80 3,000 10 2000 Min VTI ml 5 200 5 OFF - bpm 10 70 1 OFF Rate Max Leak (leakage configuration) Max Rtot PIP – Peak Inspiratory Pressure When Relative Pressure is set to YES in the Setup Menu, PIP allows you to determine inspiratory pressure added to PEEP during the inspiratory phase. In this configuration, the sum of PIP and PEEP must not exceed 55 mbar. When Relative Pressure is set to OFF in the Setup Menu, PIP allows you to determine inspiratory Absolute pressure. In this configuration, PIP and PEEP are related and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration. PEEP – Positive End Expiratory Pressure PEEP allows you to determine the level of pressure maintained during the exhalation phase. When Relative Pressure is set to YES in the Setup Menu, the sum of PIP and PEEP must not exceed 55 mbar. When relative pressure is set to OFF, PIP and PEEP are related and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration. The ventilation mode can be adjusted without PEEP (PEEP is nearly 0 mbar when set to “OFF”) in valve configuration. In leak configuration, the minimum PEEP setting is 4 mbar. Rise Time This parameter is used during the inspiration phase to adjust how the pressure setpoint will be reached. This setting indirectly defines the minimum inspiratory time. The different levels available are as follows: 3-10 Rise time = 200 ms Rise time = 400 ms Rise time = 600 ms Clinician’s Manual P A/C Mode Parameters and Setting Ranges Rise time = 800 ms These time ranges are determined by the combination of the pressure setting required, the breath rate and the physiological conditions of the patient. The pressure rise time built-up at each cycle depends on the inspiratory time corresponding to the combination of the rate setting and the Insp Time setting. • • • • Rise Time is always possible Rise Time is established only if Insp Time 0.7 seconds Rise Time is established only if Insp Time 0.9 seconds Rise Time is established only if Insp Time 1.1 seconds. Note: Insp Time is not a setting and is displayed as Ti when the I:E or I/T ratio is adjusted. Rate – RESPIRATORY RATE Rate allows you to define the minimal frequency of mandatory ventilator breaths. If the patient actuates the inspiration trigger, Total Rate may increase. Note: Insp Time is not a setting and is displayed as Ti when the I:E or I/T ratio is adjusted. I:E (I/T) Cycling rate I:E allows you to determine the ratio between the inspiratory breath phase duration and the exhalation breath phase duration. I/T allows you to determine the ratio between the inspiratory breath phase duration and the total breath duration (inhalation + exhalation). Note: Insp Time is not a setting and is displayed as Ti when the I:E or I/T ratio is adjusted. I Sens – INSPIRATORY TRIGGER SENSITIVITY I Sens allows you to set the level of inspiratory effort the patient has to provide to initiate a machine breath. The sensitivity levels decrease from 1P to 5: the lower the number, the more sensitive the trigger sensitivity. These levels correspond to differences in flow compared to the bias flow. I Sens 1 (P) = Bias flow + (0.4 lpm to 1 lpm) (P = Pediatric use) I Sens 2 = Bias flow + (0.7 lpm to 1.3 lpm) I Sens 3 = Bias flow + (0.9 lpm to 1.5 lpm) I Sens 4 = Bias flow + (1.0 lpm to 1.6 lpm) I Sens 5 = Bias flow + (1.2 lpm to 1.8 lpm) The bias flow consists of turbine flow through the patient circuit, during the exhalation phase, that helps the patient avoid rebreathing exhaled gas (CO2). The inspiratory trigger is initiated after a time delay of between 700 ms to 1500 ms, depending on the preceding peak inspiratory flow. I Sens can be set to OFF. WARNING The inspiration trigger threshold should be carefully modified in order to avoid the risk of false triggering or “autotriggering” of the ventilator. For example, Level 1P, the most sensitive mode, is recommended for pediatric use. However, for an adult, this setting may result in autotriggering. Clinician’s Manual 3-11 Operating Parameters VT Target - TARGET TIDAL VOLUME VT Target allows the ventilator to deliver a target volume of air to the patient. When a VT Target is set, the ventilator constantly adjusts the target inspiratory pressure between PIP and Max P to ensure the inspired tidal volume remains as close as possible to the VT target. VT Target should be more than 10 ml lower than Max VTI to avoid triggering VTI alarm. The minimum increase or decrease of target inspiratory pressure is 0.5 mbar and the maximum is 2 mbar. Setting the Vt Target is not mandatory (it can be set to “OFF”). Max P - MAXIMUM INSPIRATION PRESSURE Max P allows the ventilator to adjust the inspiratory pressure up to a maximum limit in order to reach the Target Tidal Volume. (Vt Target) PIP and Max P are related and the difference between them must be less than 20 mbar. Max P is not displayed when VT Target is set to OFF. VTI (Min and/or Max Alarm Settings) – INSPIRATORY TIDAL VOLUME It is possible to set a Min and/or Max Tidal Volume alarm threshold for the patient’s inspired tidal volume during a cycle. This setting is used to trigger an alarm if the tidal volume inspired by the patient is lower than the minimum threshold set (“LOW VTI” alarm), or greater than the maximum threshold set (“HIGH VTI” alarm). Refer to chapter 5, “Alarms and Troubleshooting”. Min VTI and Max VTI are related and their settings must be set to values that maintain a minimum difference of 20 ml between the two. It is not mandatory to set the minimum and maximum VTI alarm limits. When the minimum and maximum VTI alarm limits are not set, the display will read “OFF” for these settings. Max Leak The setting of a high leakage threshold enables a “HIGH LEAKAGE” alarm to be triggered in the event the calculated leakage flow exceeds this limit. The displayed value corresponds to the mean parasite leakage flow observed during the exhalation phase. Max Rtot (Max Alarm Setting) – TOTAL BREATH RATE The maximum rate threshold setting is used to warn of hyperventilation or autotriggering of the ventilator. This setting is used to trigger the “HIGH RATE” alarm. Refer to chapter 5, “Alarms and Troubleshooting”. The Max Rtot threshold must always be set at least 5 bpm higher than the Rate. If the Rate is readjusted, the Max Rtot is automatically readjusted to maintain a minimum difference of 5 bpm. Setting the Max Rtot is not mandatory (it can be set to “OFF”), but the measured value is always displayed. 3-12 Clinician’s Manual FiO2 For Various Oxygen and Ventilator Settings 3.4 FiO2 For Various Oxygen and Ventilator Settings Inhalation flow (LPM) = Volume (L) x 60 / Inspiratory time (S) Figure 3-7. Fi02 for Oxygen and Ventilator Settings Note: Tests conducted in a valve configuration. Results can vary according to whether the circuit is configured with or without a valve and patient lung characteristics. WARNING The Puritan Bennett™ 520 Ventilator can be used with an oxygen analyser with minimum and maximum concentration alarms. Always measure the delivered oxygen with a calibrated oxygen analyser that features a minimum and maximum concentration alarm in order to ensure that the prescribed oxygen concentration is delivered to the patient. Clinician’s Manual 3-13 Operating Parameters This page intentionally blank 3-14 Clinician’s Manual Digital Monitoring 4 Monitored Parameters During ventilation, ventilator parameters measured or calculated are highlighted in the menus used for setting the ventilation parameters and the alarms. In addition to the display of monitored ventilation parameters, ventilation is displayed graphically, by the pressure bar chart, in the ventilation parameters setting menu. Note: To monitor patient Oxygen levels use an external sensor/alarm. 4.1 Digital Monitoring The ventilation parameters monitored or calculated are highlighted in each of the main menus: • Ventilation menu (Figure 4-1, Figure 4-2) • Alarm menu ( Figure 4-3, Figure 4-4) Figure 4-1. Ventilation Menu: Pressure Leakage Configuration Modes (CPAP, PSV ST, P A/C) Figure 4-2. Ventilation Menu: Pressure Valve Configuration Modes (PSV ST, P A/C) Clinician’s Manual 4-1 Monitored Parameters ASK PIERRE ARIES FOR Figure 4-3. Alarm Menu: Pressure Leakage Modes (CPAP, PSV ST, P A/C) Figure 4-4. Alarm Menu: Pressure Valve Modes (PSV ST, P A/C) Inspiratory Trigger During each inspiration phase triggered by the patient, the Inspiratory Effort Detected symbol is displayed beside the cycling I:E ratio in the ventilation or alarm menus (see Figure 4-5). The patient triggers the ventilator by inhaling the amount of flow and the ventilator responds by delivering either a pressure-based or volume-based breath. Figure 4-5. Inspiratory Effort Detected Indicator 4-2 Clinician’s Manual Digital Monitoring Displayed Monitored Parameters Table 4-1. Displayed Monitored Parameters Monitored Parameters Display I:E Ratio I:E I/T Ratio (I/T) I/T Inspiratory Tidal Volume VTI Inspiratory Time I Time Leak Leak Minute Volume M Vol Peak lnspiratory PIP Pressure Positive End Expiratory Pressure PEEP Rate Rtot Clinician’s Manual Description I:E is the ratio of inspiratory time measured to exhalation time measured. The displayed value is updated at each inspiration. I/T is the breath inspiratory time divided by the total breath cycle time expressed as a percentage. The displayed value is updated at each inspiration. Flow delivered by the ventilator to the patient at each inspiratory phase is measured by the inspiratory transducer and that measurement is used to calculate volume (the flow transducers do not directly measure volume). The displayed value is updated at each inspiration. Currently when a Pressure Controlled or Pressure Support breath is delivered in valve ventilation and a leak is present, the ventilator will increase flow to reach the pressure target. The monitored VTI in Pressure Controlled or Pressure Support breaths reflects the amount of flow the ventilator delivers from the outlet port during inhalation. The monitored value will increase (possibly to an abnormally high number) when a leak is present. This displayed value is not what is delivered to the patient. Inspiratory time measured. Available only when patient circuit is in leak configuration. Flow delivered at each breath to the patient is measured by the inspiratory transducer and that measurement is used to calculate minute volume (Vt x Rtot) (the flow transducers do not directly measure volume). The displayed value is updated at each exhalation. Highest circuit pressure during each inspiration phase measured with the proximal pressure sensor. The displayed value is updated at each exhalation. End exhalation pressure is measured by the proximal pressure sensor. The displayed value is updated at each inspiration. Total number of breaths measured per minute. The displayed value is based on each breath and is updated at each inspiration. 4-3 Monitored Parameters 4.2 Bargraph Display In the ventilation menu, the highlighted bargraph dynamically displays pressures established throughout the breath cycle (Figure 4-6). 1 2 Figure 4-6. Bargraph Display The PIP value reached during a cycle is represented by a line at the top of the bargraph (Figure 4-6, item 1) which remains displayed until the maximum value of the following cycle has been reached. The PEEP value is represented by a line at the bottom of the bargraph (Figure 4-6, item 2). 4.3 Ventilation Report The Ventilation Report is available in the Preferences Menu (refer to chapter 7, “Operating Procedures”). The Ventilation Report updates daily at 8am and shows the average readings from the previous 24 hours. Refer to Figure 4-7. Figure 4-7. Ventilation Report Note: The values displayed in the Ventilation Report are reinitalised when the software is updated or the patient hours counter is reset to zero. The following data are displayed in the Ventilation Report: Vent Time - Ventilation Time The ventilation duration data are based on the patient counter and shows the total ventilation time in hours and minutes over the previous 24 hour period. 4-4 Clinician’s Manual Ventilation Report VTI - Inspired Tidal Volume When ventilating with an exhalation valve, the VTI is the average inspired tidal volume during each ventilation cycle over the previous 24 hour period. When ventilating in leak mode, the VTI is the average volume delivered by the ventilator during each ventilation cycle over the previous 24 hour period. PAW - Peak Airway Pressure The Peak Airway Pressure is the average peak pressure during the inspiratory phase, measured by each cycle and over the previous 24 hour period. Rate - Respiratory Rate The Respiratory Rate is the average of the total respiratory frequency of the patient and the ventilator measured over the previous 24 hour period. Leak When ventilating with a leak configuration circuit, it is the average patient / circuit leak during each cycle and over the past 24 hour period. When ventilating with a single limb circuit with valve there is no average leak. AI - Apnea Index The Apnea index is average number of apnea events per hour of ventilation. It is based on the Apnea Alarm. Apnea Ti - Apnea Time Accumulated apnea time over the previous 24 hour period. Spont Cyc - Spontaneous Cycling This is the percentage of ventilation cycles initiated by the patient and the ventilator over the previous 24 hour period. Machine Total time in hours that the ventilator has been switched on since manufacture. Patient Total time in hours and minutes that the current patient has been ventilated. Clinician’s Manual 4-5 Monitored Parameters This page intentionally blank 4-6 Clinician’s Manual Alarm Level of Priority 5 Alarms and Troubleshooting WARNING Setting Alarm limits to extreme values can cause the ventilator alarms to malfunction. When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator. Alarm volume should be adjusted with respect to the ventilator’s operating environment and so that the patient's caretakers can hear the alarms. The audible alarm vents located at the front of the device should never be obstructed. See section 7.3.4 , “Alarm Volume,” on page 7-12. The alarms or faults generated by your Puritan Bennett™ 520 Ventilator are classified into two categories: • Ventilation (or utilisation) alarms • Technical faults Some of the ventilator alarms are adjustable, depending on ventilation modes (refer to chapter 3, “Operating Parameters”). Automatic, non-adjustable alarms also exist to create a safety net for safer patient ventilation. Alarms indicate events likely to affect the ventilation in the short term and necessitate rapid intervention (refer to section 5.8, “Troubleshooting,” on page 5-14). Technical faults do not directly affect machine operation. Therefore, the user is not alerted to technical faults. Only authorised and trained technicians may consult the maintenance menu (refer to the Puritan Bennett™ 520 Ventilator Service Manual). Note: Default alarm setting preferences should be entered prior to using the ventilator. 5.1 Alarm Level of Priority The alarm hierarchy for signalling the level of alarm criticality is listed below. • Very High Priority (VHP): Immediate critical situation; ventilation is impossible: Continuous Sound Signaling / With or Without Continuous Red LED Illumination / With or Without Message / With or Without Display Lighting (it is possible for an alarm condition to occur that may not have both a message and lighting). • High Priority (HP): Critical situation in the short term; ventilation is potentially compromised: High Speed Intermittent Sound Signaling / Flashing Red LED Illumination / With Message / With Display Lighting • Medium Priority (MP): Critical situation in the long term; ventilation is not affected in the short term: Medium Speed Intermittent Sound Signaling / Flashing Yellow LED Illumination / With Message / With Display Lighting Clinician’s Manual 5-1 Alarms and Troubleshooting Note: There are currently no Low Priority (LP) Alarms. If there is no corrective action and if the audible alarm is not inhibited (Audio Paused) or reset (Alarm Reset) within 60 seconds, High Priority alarms will sound at the maximum level of 85 dB(A). 5.2 Alarm Display During operation, when an alarm is activated: • One of the red or yellow alarm indicators to the left of the ALARM CONTROL key illuminates and flashes. • An alarm tone sounds. • A message is displayed and flashes in reverse video at the bottom of the Ventilation Menu or Alarm Menu. ALARM INDICATORS VENTILATION MENU ALARM MENU ALARM MESSAGES Figure 5-1. Alarm Displays Note: There are currently no Low Priority (LP) Alarms. When an alarm is triggered, if the current menu displayed is not the Ventilation parameters or Alarm menu, the display automatically switches to one of these menus to display the alarm message. 5-2 Clinician’s Manual Alarm Log Menu In the event several alarms are activated at the same time, the highest priority audible and visual alarm is highlighted; however, all active messages are displayed, in the sequence in which they occurred. 5.3 Alarm Log Menu All alarms are recorded in the internal memory of the ventilator at the time they are activated. The Alarm Log menu is used to display the last eight (8) alarms activated, along with their date and time of activation. To access the Alarm Log menu, do the following: 1. Press the MENU key to access the alarm setting menu (if this is not the menu currently displayed). 2. Press the DOWN key several times or press until the cursor is on the “Alarm Log” line at the bottom of the page. The display appears as follows: Figure 5-2. Accessing Alarm Log Menu 3. Press the ENTER key. The Alarm Log screen is displayed. Figure 5-3. Displaying the Alarm Log Screen Note: When no alarm has been activated, “NO DATA” is displayed on the screen (see Figure 5-4). Clinician’s Manual 5-3 Alarms and Troubleshooting Figure 5-4. Alarm Log Display when No Alarm Activated For more information on the “USER’S CLEAR ALERTS” line, refer to section 5.6, “Re-activating Alarms,” on page 5-6. To dismiss the Alarm Log screen manually: Press the ENTER key when the cursor is on the “Back” line. The Alarm Log screen is dismissed automatically: • After 15 seconds if no keyboard action is detected • When a High Priority alarm is triggered Note: Only qualified service personnel may access all alarms and events recorded by the ventilator. Qualified personnel should refer to the Puritan Bennett™ 520 Ventilator Service Manual for further information. 5.4 Silencing the Audible Portion of Alarms You may silence the audible portion of alarms for 60 seconds at a time. This is referred to as the Audio Paused function. To silence the audible portion of activated alarms: Press the ALARM CONTROL key. • The audible portion of all activated alarms is paused. • The visual portions (light indicator and message) of activated alarms remain visible. • The Audio Paused symbol is displayed at the top right of the screen while the audio pause function is active. Figure 5-5. Silencing the Audible Portion of Alarms 5-4 Clinician’s Manual Pausing/Resetting Alarms If several alarms are activated at the same time, pressing the ALARM CONTROL key affects all current alarms. The audible portion of activated alarms is automatically reactivated: • After 60 seconds, if the cause(s) of the alarm(s) persist(s) • Whenever a new alarm is activated Note: If a key is stuck or held down for 45 seconds a keypad alarm will occur. 5.5 Pausing/Resetting Alarms WARNING When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator. Alarm volume should be adjusted with respect to the ventilator’s operating environment and so that the patient's caretakers can hear the alarms. The audible alarm vents located at the front of the device should never be obstructed. See section 7.3.4 , “Alarm Volume,” on page 7-12. Some alarms are not automatically cancelled when the condition causing the alarm clears e.g. HIGH PRESSURE. Some alarms can be paused manually even if the cause(s) of their activation remain(s). To manually pause an alarm, proceed as follows: Press the ALARM CONTROL key twice. • The alarm is paused until the alarm condition is corrected and the condition reoccurs: the audible portion, light indicator, and message are all halted (for the alarms which can be paused manually). The Alarm Paused symbol is displayed at the top right of the Ventilation and Alarms screens. Refer to Figure 5-6. Figure 5-6. Manually Pausing Alarms When no other alarms are currently activated, the last alarm cancelled is displayed continuously in the alarm message window in the Alarms menu, along with the date and time of its activation. The High Pressure alarm must be manually reset. Refer to section 5.7, “Overview of Alarms,” on page 5-7. To manually reset the High Pressure Alarm, proceed as follows: Press the ALARM CONTROL key twice. • The visual alarms will be reset. Clinician’s Manual 5-5 Alarms and Troubleshooting 5.6 Re-activating Alarms Alarms that have been paused and whose activation conditions continue to exist can be reactivated. To reactivate alarms, proceed as follows: 1. Press the MENU key to access the Alarm Setting menu, if this is not the menu currently displayed. 2. Press the DOWN key to position the cursor on the “Alarm Log” line, if this is not already the case. Refer to Figure 5-7: Figure 5-7. Reactivating Alarms 3. Press the ENTER key, to confirm access to the “Alarm Log” menu. 4. Press the UP key to position the cursor on the “USER’S CLEAR ALERTS” line. Refer to Figure 5-8 : Figure 5-8. Alarm Log 5. Press the ENTER key for at least three (3) seconds. The following events occur: • • • • • • 5-6 A “beep” sounds. An audible alarm sounds. An alarm indicator illuminates. The messages of all active alarms are displayed in a loop in the Ventilation and Alarm menus. The Audio Paused symbol disappears (if it was displayed). The Alarm Paused symbol disappears. Clinician’s Manual Overview of Alarms 5.7 Overview of Alarms Note: The message: “*IF PERSISTS RESTART/SRVC” will occur only if the alarm condition continues for longer than 30 seconds. If the message “*IF PERSISTS RESTART/SRVC” occurs, restart the ventilator. If the alarm condition is not cleared, call a service representative. For corrective actions and troubleshooting of the following alarms, See Table 5-2, Alarms and Corrective Actions. Table 5-1. Overview of Alarms Priority Audio Paused Avail. Alarm Paused Avail. Alarm Message Cause/Ventilator Response AC POWER DISCONNECTION Cut-off of the AC (mains) power supply. Alarm activation occurs: • After 5 seconds if ventilation is stopped • At the start of a ventilation cycle when ventilation is in progress. Consequence: the ventilator will automatically switch to external DC power supply if present, otherwise to the internal battery. MP Yes Yes APNEA No inspiratory trigger detected by the ventilator after the apnea time set in PSV and CPAP, modes. Automatically clears itself after two successive patient breaths. MP Yes Yes – except for CPAP Ventilator has detected an internal battery fault. Consequence: the internal battery is disabled from use. MP Yes No MP Yes No MP Yes Yes MP Yes No BATTERY FAULT1 RESTART/SRVC BATTERY FAULT2 RESTART/SRVC BUZZER LOW BATTERY BUZZER FAULT1 RESTART/SRVC Clinician’s Manual No internal battery detected. Occurs when the buzzer battery is too low to sound the POWER SUPPLY LOSS alarm. Defective operation of the buzzers. BUZZER FAULT2 RESTART/SRVC Failure detected in the Very High Priority buzzer. Consequence: no audible alarm in case of POWER SUPPLY LOSS alarm. MP Yes Yes BUZZER FAULT3 RESTART/SRVC Battery Charge Failure due to incorrect voltage. Contact your service representative for assistance. HP Yes No 5-7 Alarms and Troubleshooting Table 5-1. Overview of Alarms (Continued) Priority Audio Paused Avail. Alarm Paused Avail. MP Yes Yes MP Yes Yes *IF PERSISTS RESTART/SRVC Inspired tidal volume during exhalation< 20% of Inspired tidal volume and Inspired tidal volume > 20 mL. Exhalation valve obstructed. HP Yes No CHECK EXH VALVE PRESSURE Internal ventilation fault related to exhalation valve detection sensor. (pressure sensor) HP Yes Yes MP Yes No Alarm Message Cause/Ventilator Response BUZZER FAULT4 RESTART/SRVC Buzzer Battery Failure. The Battery Buzzer Voltage is too low. Internal technical problem that prevents the battery sounding the POWER SUPPLY LOSS alarm. CHECK BATTERY CHARGE Internal battery charging failure. Consequence: charging of the internal battery impossible. IF PERSISTS RESTART/SRVC CHECK EXH VALVE* 1. Loss of signal from the proximal pressure sensor. CHECK PROXIMAL LINE1* *IF PERSISTS RESTART/SRVC Consequence: switch to internal pressure sensor for the pressure measurement. Alarm activation occurs: In the event of signal loss (1): After one ventilation cycle or In the event of signal loss (2) and after the 17th breath cycle: After 17 seconds for P A/C mode, or after the maximum time between 17 seconds and Apnea Time + 4 seconds for CPAPand PSV mode. 5-8 CHECK REMOTE ALARM No activation of Nurse Call or remote alarm system when an alarm is in progress. MP Yes Yes CHECK SETTINGS Alarm activation occurs: • Systematically after software versions have changed. • Loss of memorised parameters Consequence: • Locking Key disabled • Out-of-range settings are replaced by their default values MP Yes Yes Clinician’s Manual Overview of Alarms Table 5-1. Overview of Alarms (Continued) Priority Audio Paused Avail. Alarm Paused Avail. CONNECT VALVE OR CHANGE PRESS No exhalation valve connected with PEEP set to less than 4 mbar or PIP set to more than 30 mbar when relative pressure is set to OFF. HP Yes No CONTROLLED CYCLES The ventilator is delivering apnea ventilation at set back up rate. NA No No COOLING FAN RESTART/SRVC Ventilator cooling fan operating speed not suited to the internal ambient temperature of the device. MP Yes Yes DC POWER DISCONNECTION Cut-off of the external DC power supply. Consequence: switch-over to the internal battery. MP Yes Yes DEVICE FAULT3 RESTART/SRVC Failure in the 24 V power supply. HP Yes No DEVICE FAULT5 RESTART/SRVC Detection of a fault in the electrical power supply system. Consequence: the internal battery capacity is not displayed beside the battery symbol. MP Yes Yes DEVICE FAULT7 RESTART/SRVC Detection of a fault in internal voltage measurement. HP Yes No DEVICE FAULT9 RESTART/SRVC POST RAM Error. RAM Read/Write does not match memory setting. VHP No No DEVICE FAULT10 RESTART/SRVC POST FLASH Checksum Error. Startup FLASH computed checksum does not match memory setting. VHP No No DEVICE FAULT11 RESTART/SRVC POST EEPROM Error. Startup EEPROM does not match memory setting. VHP No No DEVICE FAULT12 RESTART/SRVC POST Reference Voltage Error. 5V or 10V reference voltage error. VHP No No VHP No No Alarm Message DEVICE FAULT13 RESTART/SRVC Clinician’s Manual Cause/Ventilator Response Software Version Error 5-9 Alarms and Troubleshooting Table 5-1. Overview of Alarms (Continued) Alarm Paused Avail. Alarm Message Cause/Ventilator Response EMPTY BATTERY Internal battery capacity < 10 min. or 3%. (battery voltage < 22.5V) Consequence: ventilation comes to a halt. HP No No Battery temperature out of tolerance. Consequence: battery charging stops. MP Yes Yes Device internal ambient temperature out of tolerance range. MP Yes Yes The LEAK estimated by the ventilator exceeds the Max LEAK alarm threshold. MP Yes No HIGH / LOW BATTERY TEMP* *IF PERSISTS RESTART/SRVC HIGH INT TEMP COOL VENT* *IF PERSISTS RESTART/SRVC HIGH LEAKAGE • In PSV, CPAP or P A/C, modes, if Inspiratory Pressure is higher than (P Support or P Control + PEEP) + 5 mbar up to 29 mbar or + 10 mbar over 30 mbar during three consecutive cycles. or • HIGH PRESSURE In PSV or CPAP mode and P Support is set to off, if Inspiratory Pressure is higher than PEEP + 10 mbar during three consecutive cycles. Alarm activation occurs: • After three consecutive breaths. Consequence: • HIGH RATE HIGH VTI 5-10 Priority Audio Paused Avail. HP Note: When alarm condition clears, alarm priority indicator must be manually reset by pressing the key. No Yes (The visual portion of the alarm may be paused) Switch to exhalation phase. Rate measured greater than Max Rtot set during three consecutive breaths. Alarm activation occurs: • After three consecutive breaths. MP Yes No Inspired tidal volume greater than Max VTI set during three consecutive breaths in PSV, CPAP, and P A/C modes. Alarm activation occurs: • After three consecutive breaths. HP Yes No Clinician’s Manual Overview of Alarms Table 5-1. Overview of Alarms (Continued) Alarm Message Cause/Ventilator Response Priority Audio Paused Avail. INTENTIONAL VENT STOP Ventilation has been stopped voluntarily by the caregiver or patient. HP Yes Yes HP No No Internal battery capacity < 30 min. or 8%. HP Yes No Inspired tidal volume less than Min VTI set during three consecutive breaths in PSV, CPAP and P A/C modes. Alarm activation occurs: • After three consecutive breaths. MP Yes No Proximal pressure < 0.6 mbar for 100 ms during inspiration phase of 3rd breath cycle. Ventilator response: Switch to internal pressure sensor for pressure measurement. MP Yes No Occurs in VALVE configuration when the tidal volume is measured below 20 mL during three consecutive breaths for PSV, CPAP, and PA/C modes. Alarm activation occurs fter three consecutive breaths; if tidal volume is less than 20 mL. HP Yes No Occurs in LEAK configuration when the LEAK level is not sufficient to flush the CO2 from patient exhalation. The built-in LEAK in the mask may be obstructed. The built-in leak for the mask is not sufficient for the settings. HP Yes No KEYPAD FAULT RESTART/SRVC* *IF PERSISTS RESTART/SRVC LOW BATTERY LOW VTI NO PROXIMAL LINE2* *IF PERSISTS RESTART/SRVC OCCLUSION CHECK CIRCUIT* *IF PERSISTS RESTART/SRVC OCCLUSION CHECK CIRCUIT Clinician’s Manual Alarm Paused Avail. Keyboard key held down for more than 45 seconds. 5-11 Alarms and Troubleshooting Table 5-1. Overview of Alarms (Continued) Priority Audio Paused Avail. Alarm Paused Avail. HP Yes No MP Yes Yes VHP No Yes PRES SENS FLT1 RESTART/SRVC Faulty internal pressure sensor signal. Alarm activation occurs: • After 15 seconds. HP Yes No PROX SENS FLT2 RESTART/SRVC Faulty proximal pressure sensor signal. Alarm activation occurs: • After 15 seconds. MP Yes Yes REMOVE VALVE The ventilation settings are not compatible with the type of patient circuit used. Remove exhalation valve to start CPAP ventilation. HP Yes No Alarm Message PATIENT DISCONNECTION* *IF PERSISTS RESTART/SRVC Cause/Ventilator Response Alarm activation occurs if conditions remain for the maximum time between: • disconnection time and 60/RRate in P A/C mode • disconnection time and (Apnea time +2 sec) in CPAP and PSV mode If the flow is greater than 130 lpm during the inspiratory phase. In PSV, CPAP and P A/C modes if patient pressure is lower than (P Support + PEEP) - 20% or (P Control + PEEP) - 20%. POWER FAULT RESTART/SRVC Detection of a fault in the electrical power supply system. 1. Electrical power supply to the machine is interrupted with the I/O switch when ventilation is in progress or POWER SUPPLY LOSS (no message) CPAP MODE 5-12 2. Battery fully discharged when it was the only source of power to the ventilator. Consequence: ventilation stops immediately. Ventilation restarts immediately when the switch is pressed in case 1 (above) or after restoration of the AC or DC supply in case 2 (above). Clinician’s Manual Overview of Alarms Table 5-1. Overview of Alarms (Continued) Priority Audio Paused Avail. Alarm Paused Avail. REMOVE VALVE OR CHANGE PRES The ventilation settings are not compatible with the type of patient circuit used. With a valve circuit, the difference between PIP and PEEP should not be less than 5 mbar. HP Yes No SOFTWARE VERSION ERROR Detection of a wrong software version. NA NA NA Turbine speed too low and temperature too high. Consequence: ventilation stops immediately and O2 supply stops. HP No No The internal battery is not recognised as a Puritan Bennett™ product battery or is not the correct battery for the Puritan Bennett™ 520 ventilator. MP Yes No Alarm Message TURB OVERHEAT RESTART/SRVC UNKNOWN BATTERY Clinician’s Manual Cause/Ventilator Response 5-13 Alarms and Troubleshooting 5.8 Troubleshooting WARNING This manual tells you how to respond to ventilator alarms, but it does NOT tell you how to respond to the patient. To ensure proper servicing and avoid the possibility of physical injury to personnel or damage to the ventilator, only personnel authorised and qualified by Covidien should attempt to service or make authorised modifications to the Puritan Bennett™ 520 Ventilator. 5.8.1 Alarms Table 5-2 offers a guide to the most likely ventilator alarms, possible reasons for the alarms, and corrective actions. WARNING Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only personnel authorised and qualified by Covidien should repair, open or service the ventilator. When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator. Note: The ventilator screen must be unlocked before setting and parameters can be changed. Table 5-2. Alarms and Corrective Actions Alarm Message or Symptom Possible Reason(s) For The Alarm Event AC (“mains”) power source cut off. Cancel the alarm then check the supply cable and/or the effective availability of a voltage on the AC power (“mains”) port. Cancel the alarm then check the power cable availability of a voltage on the AC power (“mains”) outlet. Starting with 12 – 30 VDC external power supply. Cancel the alarm. Current-limiting fuse of the device blown. Replace the ventilator and call for the maintenance technician. Patient’s breathing effort less than the Sensitivity control setting. Ensure the patient is breathing and adjust the inspiratory setting appropriately based on patient’s respiratory needs. Patient apnea. Examine the patient for breathing effort and stimulate if necessary. If patient status has changed adjust the ventilator settings based on patient’s respiratory needs. Defective sensors. Have a qualified technician replace the defective component(s) and call your customer service representative. BATTERY FAULT1 RESTART/SRVC Battery problem that prevents it from operating. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. BATTERY FAULT2 RESTART/SRVC Internal battery missing or not detected. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. AC POWER DISCONNECTION APNEA 5-14 Corrective Action(s) Clinician’s Manual Troubleshooting Table 5-2. Alarms and Corrective Actions (Continued) Alarm Message or Symptom Possible Reason(s) For The Alarm Event Corrective Action(s) BUZZER FAULT1 RESTART/SRVC Defective operation of the buzzers. Consequence: no audible tone when an alarm is activated. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. BUZZER FAULT2 RESTART/SRVC Internal technical problem that prevents the very high priority “POWER SUPPLY LOSS” alarm from triggering. Ensure that the protective cover over the I/O switch located on the rear of the device is intact and functioning properly. This cover helps prevent accidental pressing of the I/O switch and stoppage of the ventilation. Ensure that the device is stabilised. Call your customer service representative. BUZZER FAULT3 RESTART/SRVC Internal technical problem that prevents the battery from correctly charging. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. BUZZER FAULT4 RESTART/SRVC Internal technical problem that prevents the battery warning buzzer from sounding POWER SUPPLY LOSS alarm. Connect the ventilator to AC power and switch on the device using the on/off at the rear of the ventilator (I/O). Leave to charge for at least 15 minutes. If persists restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. BUZZER LOW BATTERY Buzzer battery is too low to sound POWER SUPPLY LOSS alarm. Connect the ventilator to AC power and switch on the device using the on/off at the rear of the ventilator (I/O). Leave to charge for at least 15 minutes. Battery charging impossible. Do not disconnect the ventilator from the AC power supply. Ensure that the power cable is installed according to the instructions in chapter 6, “Installation and Assembly”, so that the power cable cannot be involuntarily disconnected. In the event the internal battery capacity is low, use an alternate device to ventilate the patient. Call your customer service representative. Obstruction or abnormal damage of the exhalation valve. Clean or replace the exhalation valve and/or its control tube. Excessive moisture in the exhalation valve. Remove moisture from exhalation valve. Verify exhalation valve is seated properly. Reduce temperature of the humidifier. Defective connection or defective exhalation valve tubing. Reconnect the valve or replace the exhalation valve and/or the exhalation valve pilot pressure tube. Defective inspiratory flow sensor. Have a qualified technician replace the defective component(s) and call your customer service representative. CHECK BATTERY CHARGE CHECK EXH VALVE* *IF PERSISTS RESTART/SRVC CHECK EXH VALVE PRESSURE Clinician’s Manual The exhalation valve may not be detected by the ventilator when ventilation is started. Or the exhalation valve may be falsely detected when ventilation is started. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. 5-15 Alarms and Troubleshooting Table 5-2. Alarms and Corrective Actions (Continued) Alarm Message or Symptom Possible Reason(s) For The Alarm Event Corrective Action(s) No connection of the proximal pressure tube when ventilation starts. Reconnect the proximal pressure line. Proximal pressure line disconnected or obstructed. Reconnect the connection line or replace it if obstructed. Check for moisture or occlusion of the proximal line. Reduce humidifier temperature. Switch to a heated wire circuit. Defective proximal pressure sensor or internal leak of the machine. Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component(s) and call your customer service representative. Nurse Call or remote alarm system is disconnected. Connect the Nurse Call or remote alarm cable to the ventilator. Relay control voltage problem. Carefully monitor the patient to detect possible alarm triggering and call for the maintenance technician. Loss of memorised parameters. Check and adjust the prescribed parameters, if necessary. Software versions have changed. Check and adjust the prescribed parameters, if necessary. The ventilation settings are not compatible with the type of patient circuit used. No exhalation valve connected with PEEP set to less than 4 mbar or PIP set to more than 30 mbar when relative pressure is set to OFF. Connect exhalation valve. Decrease PIP to less than 30 mbar in absolute pressure. Increase PEEP to more than 3 mbar. Note: Always consult the clinician before changing PEEP, pressure or Rate settings. The ventilator is delivering apnea ventilation at set back up rate. Check that the patient circuit is correctly attached and the patient is correctly ventilated. Operating speed of the cooling fan not properly adjusted for the internal ambient temperature of the device. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. 12 – 30 VDC power supply cut off when there is no AC (“mains”) power supply. Cancel the alarm then check the supply wiring and/or the effective availability of voltage on the external source. Ventilator’s current-limiting fuse blown. Replace the ventilator and call your customer service representative. IF PERSISTS RESTART/SRVC 24 V supply failure. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. DEVICE FAULT5 Internal problem in the electrical power supply. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. Internal technical problem. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. CHECK PROXIMAL LINE1* *IF PERSISTS RESTART/SRVC CHECK REMOTE ALARM CHECK SETTINGS CONNECT VALVE OR CHANGE PRESS CONTROLLED CYCLES COOLING FAN RESTART/SRVC DC POWER DISCONNECTION DEVICE FAULT3 IF PERSISTS RESTART/SRVC DEVICE FAULT7 IF PERSISTS RESTART/SRVC 5-16 Clinician’s Manual Troubleshooting Table 5-2. Alarms and Corrective Actions (Continued) Alarm Message or Symptom Possible Reason(s) For The Alarm Event POST RAM Error. RAM Read/Write does not match memory setting. If patient has been disconnected, reconnect patient to reset the fault. If persists restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. POST FLASH Checksum Error. Startup FLASH computed checksum does not match memory setting. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. POST EEPROM Error. Startup EEPROM does not match memory setting. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. POST Reference Voltage Error. 5V or 10V reference voltage error. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. Incorrect software version detected. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. Internal battery capacity is less than 10 min. (or 3%) —battery operation overextended. Reconnect the device to an AC power outlet, connect it to an external DC power source, or replace the battery. Reminder: the internal battery can be charged only when the ventilator connected to an AC power supply. DEVICE FAULT9 IF PERSISTS RESTART/SRVC DEVICE FAULT10 IF PERSISTS RESTART/SRVC DEVICE FAULT11 IF PERSISTS RESTART/SRVC DEVICE FAULT12 IF PERSISTS RESTART/SRVC DEVICE FAULT13 IF PERSISTS RESTART/SRVC EMPTY BATTERY Corrective Action(s) Note: Ensure that you are operating the ventilator within the proper temperature range (refer to Appendix B, “Specifications”). Put the device in a warmer environment (if the ambient temperature is too low) or in a cooler environment (if the ambient temperature is too high). For example, ensure the ventilator is not in direct sunlight or next to an air conditioning vent. HIGH INT TEMP COOL VENT Internal ambient temperature of the device out of the tolerance ranges. WARNING In case of operation in a high ambient temperature, handle the ventilator with care; some portions of the device may have high surface temperatures. WARNING In the case of high ambient temperatures, it may take a significant period of time to cool the internal temperature of the ventilator to the proper operating range. To avoid injury to the patient, ensure that the air inspired by the patient does not exceed 41 °C (106 °F). If in doubt, replace the ventilator. Defective internal temperature probe or any other technical anomaly. Clinician’s Manual Replace the ventilator and call your customer service representative. 5-17 Alarms and Troubleshooting Table 5-2. Alarms and Corrective Actions (Continued) Alarm Message or Symptom HIGH/LOW BATTERY TEMP* Battery temperature out of the tolerance ranges. Corrective Action(s) CAUTION: Ensure that ventilator is being used according to the operating instructions found in Appendix B, “Specifications”. If the ambient temperature is too low, place the device in a warmer environment. If the ambient temperature is too high, place the ventilator in a cooler environment. For example, ensure the ventilator is not in direct sunlight or next to an air conditioning vent. The temperature fault alarm does not interfere with the operation of the ventilator. *IF PERSISTS RESTART/SRVC Defective internal temperature probe or any other technical anomaly inside the battery. HIGH LEAKAGE The LEAK estimated by the ventilator exceeds the Max LEAK alarm threshold. Readjust mask to reduce leakage or Increase the alarm settings. Adjustment of the Max VTI level too low (for PSV, CPAP and P A/C modes). Note: Always consult the clinician before changing PEEP, pressure or Rate settings. Modify the Max VTI level. Adjustment of the pressure level too high for the volume required (for PSV, CPAP and P A/C modes). Note: Always consult the clinician before changing PEEP, pressure or Rate settings. Modify the pressure level. A leak in the patient circuit causing increased bias flow. Check and properly connect the patient circuit. HIGH VTI 5-18 Possible Reason(s) For The Alarm Event WARNING In case of operation in a high ambient temperature, handle the ventilator with care; some portions of the device may have high surface temperatures. Restart ventilator to see if alarm clears. if the alarm message persists, please contact technical services. CAUTION: Do not attempt to charge a defective battery; such a battery cannot be charged. Inappropriate patient circuit. Replace the patient circuit. Defective flow sensor or internal leak in the machine. Have a qualified technician replace the defective component(s) and call your customer service representative. Clinician’s Manual Troubleshooting Table 5-2. Alarms and Corrective Actions (Continued) Alarm Message or Symptom HIGH PRESSURE HIGH RATE INTENTIONAL VENT STOP Possible Reason(s) For The Alarm Event Airway obstruction. Check patient’s trachea and clear the obstruction. If the filter is obstructed, replace the filter. Proximal pressure tube or patient circuit obstructed. Clean the proximal pressure tube or the patient circuit or replace them. Coughing or other high-flow exhalation efforts. Treat patient’s cough. Silence the alarm, if necessary. Patient inspiratory resistance or compliance changes. Have physician determine if ventilator settings are appropriate for the patient. Defective internal circuits of the machine or pressure sensor. Replace the ventilator and call your customer service representative. Adjustment of the Max Rtot level too low. Re-adjust Max Rtot. Adjustment of the I Sens level too low. Adjust I Sens according to the patient. Patient hyperventilating. Silence the alarm and call for a medical team if the symptoms persist. Check for auto-cycling and adjust inspiratory sensitivity, manage leaks or drain condensation from patient circuit. Defective inspiratory flow sensor. Have a qualified technician replace the defective component(s) and call your customer service representative. The user / caregiver has stopped ventilation usingthe VENTILATION ON/OFF key. Ventilation is in stand-by. LOW VTI Clinician’s Manual Check that the ventilation was switched off on purpose. This alarm can be deactivated. Refer to chapter 7.2.2 , “Changing the Setup Menu Parameters”. Pressing a key for more than 45 seconds. Press and release keys in the normal, prescribed manner. Do not press keys for 45 seconds or more. A key on the keyboard is stuck. If unsuccessful in releasing the stuck key(s), restart ventilator to see if alarm clears. If not, replace the device and call your customer service representative if the situation persists. Internal battery capacity is less than 30 min. (or 8%)—battery operation overextended. Immediately connect the ventilator to an AC power outlet, or connect it to an external DC power source. Reminder: the internal battery can be charged only when the ventilator is connected to an AC power supply. Adjustment of the Min VTI level too high (for PSV, CPAP andP A/C modes). Modify the Min VTI level. Adjustment of the pressure level not enough to reach the volume required (for PSV, CPAP and P A/C modes). Modify the pressure level according to the physician’s prescription. Patient circuit obstructed or disconnected. Clean, unblock, and/or reconnect the patient circuit. Inappropriate patient circuit. Replace the patient circuit. Defective flow sensor or internal leak in the machine. Check patient, replace the device and call your technician or customer service representative. KEYPAD FAULT RESTART/SRVC LOW BATTERY Corrective Action(s) 5-19 Alarms and Troubleshooting Table 5-2. Alarms and Corrective Actions (Continued) Alarm Message or Symptom NO PROXIMAL LINE2 PATIENT DISCONNECTION *IF PERSISTS RESTART/SRVC Possible Reason(s) For The Alarm Event The proximal pressure line is disconnected. Connect proximal pressure line. Adjustment of Min PIP too high. Decrease the Min PIP threshold. Leak or loose connection in the patient circuit. Circuit disconnection from patient or ventilator. Check the patient circuit connections to the ventilator; examine all connections for leakage and tightness. Replace the patient circuit if necessary. Inspiratory flow exceeds 130 LPM. Check Min PIP alarm setting. Adjust Apnea alarm setting. Inappropriate patient circuit. Replace the patient circuit. Defective internal circuits of the machine or pressure sensor. Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component(s) or call your customer service representative. Patient circuit obstructed. Clean, unblock, and/or properly connect the patient circuit. A non-vented configuration is being used or the built-in leak in the mask or in the circuit may be obstructed or insufficient for the settings. Note that a high respiratory or backup rate may not sufficiently flush out CO2 in some vented pediatric masks. Replace the non-vented circuit with a vented one. Clean, unblock the mask or the circuit of the vented system or switch to a vented system with a larger leak configuration. Try to reduce patient’s backup rate if possible. Internal problem in the electrical power supply. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. Electrical power supply cut off by the main switch when ventilation is in progress. Press the I/O switch to restore electrical power to the ventilator and allow ventilation to continue. To stop ventilation, press and hold the VENTILATION ON/OFF key for three seconds. Press the VENTILATION ON/OFF key again to confirm stop. (refer to chapter 7, “Operating Procedures”). The internal battery that supplies the ventilator is entirely discharged. Immediately connect the ventilator to an AC power outlet or an external DC power source; otherwise, use an alternate device to ventilate the patient. Defective internal pressure sensor. Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component(s) and call your customer service representative. Defective proximal pressure sensor or internal leak of the machine. Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component(s) and call your customer service representative. The ventilation settings are not compatible with the type of patient circuit used. Remove exhalation valve to start ventilation with less than 5 mbar of difference between PEEP and PIP or Increase the difference between PEEP and PIP to a minimum of 5 mbar. OCCLUSION CHECK CIRCUIT *IF PERSISTS RESTART/SRVC OCCLUSION CHECK CIRCUIT POWER FAULT RESTART/SRVC POWER SUPPLY LOSS (without message) PRES SENS FLT1 RESTART/SRVC PROX SENS FLT2 RESTART/SRVC REMOVE VALVE OR CHANGE PRES 5-20 Corrective Action(s) Clinician’s Manual Troubleshooting Table 5-2. Alarms and Corrective Actions (Continued) Alarm Message or Symptom Possible Reason(s) For The Alarm Event REMOVE VALVE CPAP MODE SOFTWARE VERSION ERROR TURB OVERHEAT RESTART/SRVC UNKNOWN BATTERY Corrective Action(s) The ventilation settings are not compatible with the type of patient circuit used. Remove exhalation valve to start CPAP ventilation. Incorrect software version detected. Call your customer service representative. Turbine overheated because of blockage during operation. Ensure lateral and front openings are not obstructed. Check air inlet filter. Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative. Internal battery not recognised as a Puritan Bennett™ product battery or the battery is not intended for the Puritan Bennett™ 520 Ventilator. Switch to a 2400 MAh battery intended for the Puritan Bennett™ 520 Ventilator or call your customer service representative. 5.8.2 Additional Troubleshooting Table 5-3 provides other possible ventilator problems, causes, and corrective actions. WARNING If the device is damaged, its external housing is not correctly closed, or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odour, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately. If you cannot determine the cause of a problem with your ventilator, contact your equipment supplier. Do not use the ventilator until the problem has been corrected. Note: Buzzer and battery alarms may occur when the unit is first powered on after the internal battery has been completely drained. Connect to an AC power source and recycle power. Table 5-3. Additional Troubleshooting and Corrective Actions Conditions Possible Causes Corrective Actions The screen backlight never switches off during ventilation Backlight set to OFF in Preferences menu. Set Backlight to YES in Preferences menu (refer to section 7.3, “Preferences Menu Parameters”). Alarm sound level too low or too high Adjustment of the alarm sound level is incompatible with the patient’s environment. Re-adjust sound level (refer to section 7.3, “Preferences Menu Parameters”). Poor visibility of the displays Contrast adjustment is incompatible with the luminosity of the environment. Re-adjust contrast (refer to section 7.3, “Preferences Menu Parameters”). Clinician’s Manual 5-21 Alarms and Troubleshooting Table 5-3. Additional Troubleshooting and Corrective Actions (Continued) Conditions Corrective Actions Unusual display on the screen Problem with the display unit. Adjust contrast or call your customer service representative if the problem persists. Ensure that the ventilator is not exposed to direct radiation from the sun. The ventilator does not operate after pressing I/O switch No external power source and the internal battery is completely discharged. Connect the ventilator to the AC power source. Turbine noise. Replace the ventilator and call your customer service representative. Filter and/or turbine silencer deteriorated. Replace the ventilator and call your customer service representative. Valve membranes damaged. Replace the ventilator and call your customer service representative. Obstruction of main or secondary air inlets of the casings. Remove obstructions from all blocked ventilator air inlets and outlets. Liquid entered the device. Replace the ventilator and call your customer service representative. Light noise Whistling noise or vibrations Excessive heat emitted Condensation inside the device 5-22 Possible Causes Clinician’s Manual Installing the Ventilator 6 Installation and Assembly WARNING Before operating the ventilator, read, understand, and strictly follow the information contained in Chapter 1, “Safety Information”. The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent. A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection. The use of a bacterial filter at the ventilator’s outlet is highly recommended. Refer to chapter 9, “Cleaning”. 6.1 Installing the Ventilator To install your Puritan Bennett™ 520 Ventilator: • Choose an area where air can circulate freely; avoid proximity to loose fabrics such as curtains. • Avoid direct exposure to sunlight. • Set the ventilator on a flat and stable surface so that its feet are all in contact with the surface. The ventilator may operate in any position, provided that the air inlets are not obstructed and the device cannot fall and possibly cause damage and/or personal injury. WARNING The operator should connect the ventilator to an AC power source whenever available, for safer operation. To ensure correct and lasting operation of the ventilator, ensure that its air circulation holes (main inlet or cooling) are never obstructed. Place the device in an area where air can freely circulate around the ventilator and avoid installing it near floating fabrics, such as curtains. Do not place the ventilator in a position where a child can reach it or in any position that might cause it to fall on the patient or someone else. Ensure that the ventilator’s immediate surroundings allow for the proper operational connection of the device without folding, pinching, or damaging any of the required cables or tubes, and that the connection of the patient circuit to the patient provides for a secure, comfortable fit. Do not operate the ventilator in direct sunlight, near heat sources, outdoors, or near installations where liquid may pose a risk without first providing adequate protection for the device. If the ambient temperature where the device is operated is greater than 35 °C (95 °F), the flow supplied at the device outlet may exceed 41 °C (106 °F). This may lead to undesirable side effects for the patient. To avoid injury to the patient move the patient and the ventilator to a cooler location. To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses. Never connect your ventilator to an electrical outlet controlled by a wall switch because the power may be inadvertently turned off. Clinician’s Manual 6-1 Installation and Assembly Even if the “INTERNAL BATTERY” charging indicator is off, charging of the battery may sometimes be incomplete if the ambient temperature is above 40 °C (104 °F) because of the battery’s internal heat safety device. The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation. The Puritan Bennett™ 520 Ventilator requires special precautions for electromagnetic compatibility and should be installed and started according to the recommendations found in Appendix B, “Specifications”. In particular, the use of nearby mobile and portable communications equipment using radio frequencies, such as mobile telephones or other systems exceeding the levels set in the IEC / EN 60601-1-2 standard, may affect its operation. Refer to section B.10, “Manufacturer’s Declaration,” on page B-9. The ventilator must not use, nor be connected to, any anti-static or electrically conductive hoses, tubing, or conduits. 6.2 Connecting to External AC Power Any of four power sources: AC power, 12 – 30 VDC power, Internal Battery power, or Auxiliary DC car adapter (cigarette lighter) can be used to power the ventilator. But when AC power is available, the ventilator will automatically select AC power as its operating power source. WARNING The power supply to which the ventilator is connected (both AC and DC) must comply with all current and applicable standards and provide electrical power corresponding to the voltage characteristics inscribed on the rear of the ventilator to ensure correct operation. Ensure that the AC power cable is in perfect condition and not compressed. The device should not be turned on if the AC power cable is damaged. Connect the external electrical power source by first connecting the power cable to the ventilator and then to the external power source. Follow the reverse procedure to disconnect the device from electrical power sources. Never connect your ventilator to an electrical outlet controlled by a wall switch because the power may be inadvertently turned off. Do not leave power cables lying on the ground where they may pose a hazard. To prevent accidental disconnection of the AC power cable, use the power cable holder (Figure 6-1, item 1) that is inserted into the notch (Figure 6-1, item 2) of the battery cover: AC Power Cable Holder. 2 1 Figure 6-1. The Power Cable Holder 6-2 Clinician’s Manual Connecting to External AC Power To secure the AC power cable: 1. Insert the power cable holder (Figure 6-2, item 1) into the notch of the battery cover. 1 2 Figure 6-2. Inserting the Power Cable Holder Into the Notch 2. Push the AC power cable into the power cable holder (Figure 6-2, item 2). 3. Connect the female end of the ventilator’s AC power cable (Figure 6-3, item 1) to the AC connector on the back of the ventilator. 1 Figure 6-3. Power Cable Connected to the Ventilator 4. Connect the male end of the AC power cable to the AC power outlet. • The AC POWER indicator on the top left corner of the ventilator illuminates. • The indicator flashes while the battery charges and then turns off when the battery is fully charged. (Refer to Figure 6-4 on page 6-4.) If the AC power cable becomes disconnected or the AC power source fails, an “AC POWER DISCONNECTION“ alarm signals an automatic switch to the external DC power source (if the DC power cable is connected) or to the ventilator’s internal battery. One of three power indicators, located on the upper-left of the ventilator’s front panel, illuminates to signal which of the three possible power sources are currently in use by the device (refer to Figure 6-4). Note: The only time the AC POWER and indicators are illuminated at the same time is when the ventilator is connected to an AC supply and the battery is charging (indicator is flashing). Clinician’s Manual 6-3 Installation and Assembly Figure 6-4. Power Indicators To disconnect the AC power cable: 1. Disconnect the AC power cable from the AC power outlet. 2. Disconnect the AC power cable from the ventilator’s AC connector at the rear of the device. 3. Grasp the AC power cable at the level of the power cable holder and turn the cable counterclockwise while lifting it upwards and out of the holder. 6.3 Connecting to an External DC Power Source WARNING Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12– 30 VDC power source (via the DC power cable) does not enable charging of its internal battery. When using a car auxiliary adapter (cigarette lighter) ensure the car has been started prior to plugging in the ventilator’s DC adapter. Note: An alternative means of ventilation should always be available, particularly when the patient is in transit or away from wall power. While using the ventilator on external battery power it is vital that a qualified caregiver (capable of providing necessary corrective actions in the event of alarm conditions) is present. When AC power is not available use an external DC power prior to using internal battery power. To connect the ventilator to an external power source do the following: 1. Ensure the car’s engine is started prior to connecting the ventilator. 2. Firstly connect the DC power cable into the ventilator. 3. Then connect the DC power cable into the car auxiliary adapter. 6-4 Clinician’s Manual Connecting to an External DC Power Source Note: Whenever AC power is unavailable, the ventilator can operate from a continuously powered external 12 – 30 VDC power source via a DC power cable (Figure 6-5, item 1) that connects to the ventilator’s rear panel DC power input connector (Figure 6-5, item 2). The DC power cable is optional; refer to Appendix H, “Parts and Accessories”, for more information. It is possible to use the DC auxiliary port (cigarette lighter) in a car as a power source. 1 2 Figure 6-5. Connecting the Ventilator to an External DC Power Source WARNING Connect the external DC power source by first connecting the power cable to the ventilator and then to the external DC source. Follow the reverse procedure to disconnect the device from the external DC power source. To connect the DC power cable to the ventilator: 1. Line up the red marker dot on the ventilator’s DC power connector with the marker on the DC power cable (Figure 6-6, item 1). 1 Align the red markers (dots and/or lines) before connecting the cable. 3 2 Push in to Connect the DC Power Cable Figure 6-6. Connecting the DC Power Cable to the Ventilator 2. Push the DC power cable onto the ventilator’s DC power connector (Figure 6-6, item 2). • You will hear a locking “click”. • The DC POWER indicator on the top left corner of the ventilator illuminates (see Figure 6-4). Clinician’s Manual 6-5 Installation and Assembly To disconnect the DC power cable from the ventilator, slide the locking ring (Figure 6-6, item 3) back and pull the plug away from the ventilator’s rear panel to disengage it. An “DC POWER DISCONNECTION“ alarm signals an automatic switch to the internal battery in case the external DC power source fails or becomes disconnected. 6.4 Patient Circuit WARNING Before opening the packaging for the Patient Circuit, ensure that no damage is evident to the packaging or its contents. Do not use if evidence of damage exists. For pediatric use, ensure that the patient circuit type fits, and, in all respects, is suitable for use with a child. Use a pediatric circuit for patients that weigh under 53 lb. (23 kg). See Table H-2, List of Circuits on page H-2 for a list of recommended patient circuits. The patient circuit should always be positioned to avoid hindering the patient's movements, to prevent accidental disconnection or leakage, and to minimise the risk of patient strangulation. Ensure that the ventilator’s immediate surroundings allow for the proper operational connection of the device without folding, pinching, or damaging any of the required cables or tubes, and that the connection of the patient circuit to the patient provides for a secure, comfortable fit. and should be changed according to The patient circuit is intended for single use by a single patient the manufacturer’s recommendations and according to the patient circuit lifetime. Refer to the instructions for use supplied by the manufacturer of the patient circuit (included with the ventilator) and chapter 6, “Installation and Assembly”. After assembling, cleaning, or reassembling the patient circuit, and on a daily basis, inspect the hoses and other components to ensure that there are no cracks or leaks and that all connections are secure. To ensure proper performance of the ventilator, use a patient circuit recommended by Covidien in this manual; refer to chapter 6, “Installation and Assembly” and Appendix H, “Parts and Accessories”. The total specified length of the patient circuit tubing as measured from the ventilator outlet to the ventilator inlet is 1.1 metres (3.6 feet) to 2.0 metres (6.6 feet). The tubing must conform to all applicable standards and must be fitted with Ø 22 mm terminals that also conform to all applicable standards. Ensure that both the length and the internal volume of the patient circuit are appropriate for the tidal volume: a corrugated tube of Ø 22 mm for adult patients, and a corrugated tube of Ø 15 mm for pediatric patients with a tidal volume lower than 200 ml. Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration. Users must always possess an additional breathing circuit and exhalation valve while using the Puritan Bennett™ 520 Ventilator. 6.4.1 Choosing the Patient Circuit Type Be sure to choose the appropriate circuit in the menu preferences; in particular, ensure that Pediatric Circuit Yes/No is set to YES when using a pediatric circuit (refer to Appendix H, “Parts and Accessories”). For information regarding validated circuits, visit the SolvITSM Center Knowledge Base by clicking the link at http://www.respiratorysolutions.covidien.com or contact your Puritan Bennett™ product representative. 6-6 Clinician’s Manual Patient Circuit 6.4.2 Installing the Patient Circuit The patient circuit is mounted depending on the setup of the circuit used and the accessories used. The following procedures describe the installation of the patient circuit with a humidifier. To add other accessories, refer to the installation instructions for the specific accessories used. To connect a single limb circuit with an exhalation valve: (refer to Figure 6-7) 1. Inspect the components of the patient circuit for any signs of damage, such as cracks (which might cause leakage). Do not use damaged components to assemble the patient circuit. 2. Install the bacteria filter (item 3) on the TO PATIENT outlet port, as shown. 3. Attach one end of the short circuit tubing (item 4) to the bacteria filter (item 3). 4. Attach the other end of the circuit tubing (item 4) to the inlet port of the humidifier (item 10). 5. Place a water trap (item 5) between the outlet port of the humidifier and the inlet of the exhalation valve (item 7). 6. Ensure the exhalation valve (item 7) is placed as close as possible to the patient. 7. Connect one end of the proximal pressure tubing (item 11) to the proximal pressure port on the exhalation valve (item 8) and the other end onto the ventilator patient pressure port (item 2). 8. Connect one end of the exhalation valve tubing (item 9) to the exhalation valve port on the exhalation valve (item 7) and the other end onto the ventilator exhalation valve port (item 1). 9. Place a patient interface to the end of the patient circuit (item 6). Figure 6-7. Single Limb Patient Circuit With Exhalation Valve Note: Although shown here, the humidifier (item 10), water trap (item 5), and tubes upstream of the single limb patient circuit are not included with the ventilator. Contact your supplier for more information. Clinician’s Manual 6-7 Installation and Assembly Figure 6-8. Close-up of Exhalation Valve Tube and Proximal Pressure Tube Figure 6-8 shows details of the connections of the proximal pressure tube (item 1) and the exhalation valve tube (item 2). To connect a single limb circuit without an exhalation valve (NIV only): Refer to Figure 6-9. 1. Inspect the components of the patient circuit for any signs of damage, such as cracks (which might cause leakage). Do not use damaged components to assemble the patient circuit. 2. Install the bacteria filter (item 1) on the TO PATIENT outlet port, as shown. 3. Attach one end of the short circuit tubing (item 2) to the filter (item 1). 4. Attach the other end of the circuit tubing (item 2) to the inlet port of the humidifier (item 6). 5. Place a water trap (item 3) between the outlet port of the humidifier and the patient end of the patient circuit. 6. Connect one end of the proximal pressure tubing (item 7) as close as possible to the patient at the mask or cannula entry (item 5) and the other end onto the ventilator patient pressure port (item 8). 7. Place a vented (NIV) interface to the end of the patient circuit (item 4). 6-8 Clinician’s Manual Patient Circuit Figure 6-9. Single Limb Patient Circuit Without Exhalation Valve The end of the proximal pressure tube should be connected as close as possible to the patient (at the mask or cannula entry, if possible) so that the ventilator can account for all load losses due to the circuit and its potential accessories. If this is not possible, it is best to modify the PATIENT DISCONNECTION triggering threshold by setting a Max VTI alarm limit for pressure modes. As a reminder: Ensure that the length and the internal volume of the patient circuit are compatible with the tidal volume: ringed tube Ø 22 mm for adults and ringed tube Ø 15 mm for pediatric patients with tidal volumes lower than 200 ml. Use, if necessary, a 22F-15M link on the outlet. WARNING When using non-invasive ventilation (NIV), without an exhalation valve, use a vented nose or face mask or a non vented mask combined with a leak accessory. When using non-invasive ventilation (NIV), with an exhalation valve, use a non vented mask. The level of inspiratory resistance of the circuit and accessories (bacteria filter, humidifier, HMEs etc) must be as low as possible. Settings—particularly the PATIENT DISCONNECTION alarm, maximum inspired volume (Max VTI), and minimum inspired volume (Min VTI) settings—must be periodically adjusted according to changes in the patient circuit resistance—especially when filters are replaced. Adding attachments to the ventilator breathing system can cause the pressure during exhalation at the patient connection port to increase. The exhalation valve must allow rapid discharge of the circuit pressure. Ensure that the exhalation valve is always clean and its evacuation aperture (exhaust port) is never obstructed. Clinician’s Manual 6-9 Installation and Assembly Do not start ventilation until you ensure that the device is suitably assembled, that the air inlet filter is properly installed and is not obstructed, and that there is proper clearance all around the unit. Also ensure that the patient circuit is suitably connected to both the ventilator and the patient and that the patient circuit, including all hoses, is not damaged or obstructed. Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration. 6.5 Filters WARNING Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over (see chapter 10, “Routine Maintenance”). This is particularly important when the ventilator is installed on a wheelchair, because environmental conditions may cause the filter to become dirty more rapidly. The ventilator features two filter types: • air inlet filter • bacteria filter Air Inlet Filter Consisting of foam and fine particle filter media and located at the rear of the ventilator, this filters the air as it enters the ventilator. Figure 6-10. Air Inlet Filter WARNING The air inlet filter is for use on a single patient and is not reusable; do not attempt to wash, clean, or reuse it. Failing to replace a dirty air inlet filter, or operating the ventilator without a filter, may cause serious damage to the ventilator. Bacteria Filter It is highly recommended that you install a bacteria filter (see Figure 6-11) on the single limb patient circuit, connected to the TO PATIENT port: 6-10 Clinician’s Manual Humidifier This filter protects the ventilator from contamination by the patient (primarily, rebreathed gas). Refer to Figure 6-11, item 1. Figure 6-11. Bacteria Filter Refer to the manufacturer’s instructions for more information about the use and maintenance of the bacteria filter(s). 6.6 Humidifier The humidifier (Figure 6-12) adds moisture (water vapour) and warms the gas in the patient circuit. It is inserted into the patient circuit between the main outlet and the patient (refer to Figure 6-8 and Figure 6-9). WARNING During invasive ventilation (when an artificial airway bypasses the patient’s upper respiratory system), the patient’s upper respiratory system cannot humidify the incoming gas. For this reason, the use of a humidifier, to minimise drying of the patient’s airways and subsequent irritation and discomfort, is required. Always position a humidification device so that it is lower than both the ventilator and the patient. Use water traps, if necessary, to limit water in the patient circuit and periodically empty these water traps. If a heated humidifier is used, you should always monitor the temperature of the gas delivered to the patient. Gas delivered from the ventilator that becomes too hot may burn the patient's airway. Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration. Figure 6-12. Humidifier When a humidification device is used, any condensation that forms in the patient circuit is collected in the water trap. If you notice any moisture in the patient circuit, you need to replace the wet circuit components with dry ones. Clinician’s Manual 6-11 Installation and Assembly Refer to the humidification device’s instruction for information on operating, cleaning, and sterilising the humidifier. 6.7 Oxygen WARNING The ventilator must not be used with flammable anesthetic substances. To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses. 6.7.1 Administering Oxygen WARNING Oxygen therapy for patients with respiratory failure is a common and effective medical prescription. However, be aware that inappropriate oxygen use may potentially lead to serious complications, including, but not limited to, patient injury. Oxygen administered to the patient is introduced from an external source into the machine through the oxygen connector at the rear of the ventilator. It is then integrated into the total volume of delivered gas. Remove the oxygen inlet connector from the back of the ventilator when external oxygen is not in use. The specific oxygen flow to the patient depends on the physiological characteristics of the patient and the ventilator settings. The oxygen flow setting should be adjusted for each patient and established in relation to a calibrated oxygen analyser. Since the factors that affect administered oxygen flow may change over time, you must ensure that these settings always correspond to the current oxygen therapy objectives specified by the physician. (Refer to section 3.4, “FiO2 For Various Oxygen and Ventilator Settings”). WARNING To avoid injury to the patient and/or possible damage to the ventilator: before using the ventilator, use a flow meter (flow regulator) to regulate the oxygen supply to specifications before connecting the ventilator to the oxygen supply. Ensure that the oxygen supply pressure to the machine never exceeds 7 psi (50 kPa) or a flow of 15 lpm. Refer to Table B-8 on page B-3 for sensitivity tolerances. The Puritan Bennett™ 520 Ventilator can be used with an oxygen analyser with minimum and maximum concentration alarms. Always measure the delivered oxygen with a calibrated oxygen analyser that features a minimum and maximum concentration alarm in order to ensure that the prescribed oxygen concentration is delivered to the patient. 6-12 Clinician’s Manual Oxygen 6.7.2 Connecting the Oxygen Supply WARNING Ensure that the only gas supplied to the ventilator through the dedicated oxygen supply connector is medical-grade oxygen. The hose connecting the ventilator to the oxygen source must be designed exclusively for use with medical-grade oxygen. Under no circumstances should the oxygen hose be modified by the user. In addition, the hose must be installed without the use of lubricants. A connector (Figure 6-13, item 1) for an external low pressure oxygen source is available at the rear of the ventilator. It is essential that you also use the special coupler (item 2) supplied with the ventilator to attach the external low pressure oxygen source to the connector. The connector is also fitted with a non-return airtight valve system. The non-return airtight valve system includes a stud (item 3) and a locking tab (item 4). 1 2 3 4 Figure 6-13. Rear Panel Oxygen Connector WARNING Before connecting the oxygen supply, ensure that the stud on the oxygen connector (Figure 6-13, item 3) is protruding outwards. Inspect the oxygen coupler (Figure 6-14, item 2) before use to ensure it has its black o-ring attached and in good condition. Do not use an oxygen coupler with a missing, damaged, or worn o-ring. To connect the oxygen supply system to the ventilator: Refer to Figure 6-14 as required: 1. Inspect the oxygen supply’s connector (Figure 6-14, item 1) to ensure that connector’s black O-ring (item 2) is not missing. 2. Push the oxygen supply’s oxygen connector (item 1) into the ventilator’s oxygen connector (Figure 6-14, item 3). • The ventilator’s oxygen connector’s locking stud (item 4) retracts. Clinician’s Manual 6-13 Installation and Assembly • The ventilator’s oxygen connector’s locking tab (item 5) is released, ensuring that the oxygen connection is locked and secured in place. 1 2 4 5 3 Figure 6-14. Connecting the Oxygen Supply System To disconnect the oxygen supply system from the ventilator: Note: Ensure the oxygen source is turned off prior to placing the ventilator in Standby or turning off the ventilator. 1. Stop the oxygen flow from the oxygen supply. 2. Press the locking tab of the ventilator’s oxygen connector, as shown in Figure 6-15, to unlock the oxygen connection. Figure 6-15. Disconnecting the Oxygen Supply System 3. Disconnect the oxygen supply’s oxygen connector by pulling it towards you. The ventilator’s oxygen connector’s locking stud (Figure 6-14, item 4) will then extend outwards, which is required before the oxygen connector can be reconnected. WARNING The coupler must not remain connected to the oxygen connector unless it also connected to a leak-proof, external oxygen gas source. When an oxygen supply is not being used with the ventilator, disconnect the oxygen source completely from the ventilator. 6-14 Clinician’s Manual Fitting the Ventilator into the Dual Bag In the event of an oxygen leak, shut down the supply of oxygen at its source. In addition, remove and/or keep any incandescent source away from the device, which may be enriched with oxygen. Circulate fresh air into the room to bring the oxygen level down to normal. To prevent any interference with the internal sensors of the ventilator, do not install a humidifier upstream of the ventilator. 6.8 Fitting the Ventilator into the Dual Bag The Dual Bag is a carrying bag with a dual function. It allows the Puritan Bennett™ 520 Ventilator to either be mounted onto a wheelchair or carried as a backpack. (See .) WARNING Ensure that the ventilator is switched off and disconnected from all external power supplies before installation. To fit the ventilator into the Dual Bag do the following: 1. Open the rear panel of the Dual Bag. 2. Slip the ventilator into the Dual bag, pushing it completely to ensure a snug fit. 3. Shut the rear panel of the Dual Bag ensuring that the hook and loop fastener strips are securely fastened. Clinician’s Manual 6-15 Installation and Assembly 6.9 Mounting the Ventilator on a Wheelchair WARNING To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses. Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged. Do not operate the ventilator in direct sunlight, near heat sources, outdoors, or near installations where liquid may pose a risk without first providing adequate protection for the device. To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator. Before using the ventilator’s internal battery, ensure that the battery is fully charged and that the charge holds. Back up ventilators or those in storage should be connected to an AC power source to protect the integrity of the battery. Due to typical voltage fluctuations that occur during normal power wheelchair use, the wheelchair mains battery should never be used to power the Puritan Bennett™ 520 Ventilator, nor should the ventilator’s battery be used to power the wheelchair. The ventilator should always be connected to an independent power source (e.g. AC power, extra batteries, or DC power source). Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over (see chapter 10, ‘Routine Maintenance”. This is particularly important when the ventilator is installed on a wheelchair, because environmental conditions may cause the filter to become dirty more rapidly. To minimise the risk of damage, you must use the ventilator’s Dual Bag to transport the ventilator. See Table H-1, List of Consumables and Accessories. Figure 6-16. Using the Dual Bag 6-16 Clinician’s Manual Mounting the Ventilator on the Utility Cart To install the Dual Bag onto a wheelchair do the following: 1. Unclip the two backpack straps from the side clips. 2. Clip the suspension belt onto the central ring. 3. Secure the Dual Bag on the wheelchair’s push handle. 4. Attach the non adjustable side of the maintaining belt to the side clip of the Dual Bag. 5. Pass the maintaining belt around the back of the wheelchair. 6. Adjust the length of the maintaining belt and attach the adjustable side of the belt to the clip on the other side of the Dual Bag. 6.10 Mounting the Ventilator on the Utility Cart Match the mounting holes (item 1) on the bottom of the Puritan Bennett™ 520 Ventilator to the mounting studs (item 2) on the top of the utility cart platform. Figure 6-17. Mounting the Ventilator on the Utility Cart 1 2 Figure 6-18. Using the Utility Cart Clinician’s Manual 6-17 Installation and Assembly 6.11 Connecting the Nurse Call Cable Connect the Nurse Call cable (Figure 6-19, item 1) to the Nurse Call Monitor Connector (item 2). 1 2 Figure 6-19. Connecting the Nurse Call Cable WARNING Before using the Nurse Call system, ensure that its connections are secure and it operates properly. To connect the ventilator to a Nurse Call device, check the ventilator's compatibility with the Nurse Call device and order a suitable connection cable. Do not use Nurse Call devices that operate based on the closure of an electrical circuit, because the devices often do not take into account possible cable disconnection or a total loss of power. Ensure that the Nurse Call device is always connected to the ventilator. The Nurse call function provides for remote alerts of ventilator alarm conditions (for example, when the ventilator is used in an isolation room), and features the following: • The ventilator signals an alarm using a normally open (NO) or a normally closed (NC) signal. • A remote alarm is activated when an alarm condition occurs, unless either of the following is true: • The audio paused function is active. • The ventilator power switch is OFF. • The remote alarm port is an 8-pin female connector; allowable current is 100 mA at 24 VDC (max). 6-18 Clinician’s Manual Turning on the Ventilator 7 Operating Procedures 7.1 Turning on the Ventilator WARNING Before operating the ventilator, read, understand, and strictly follow the information contained in Chapter 1, “Safety Information”. The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent. If the ventilator has been transported or stored at a temperature that differs more than 20 °C ( 36 °F) from the temperature in which it will be operating, the ventilator should be allowed to stabilise in its operating environment for at least two (2) hours prior to use. To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses. While the ventilator is in use, an alternative means of ventilation should always be available in the event of a ventilator problem. Supplementary observation, appropriate for the patient's condition, is also recommended. To ensure that ventilation continues uninterrupted, ensure alternative power sources are available (AC power source, extra batteries, or an auxiliary DC car adapter). Be prepared for the possibility of power failure by having an alternative means of ventilation ready for use. Do not start ventilation until you ensure that the device is suitably assembled, that the air inlet filter is properly installed and is not obstructed, and that there is proper clearance all around the unit. Also ensure that the patient circuit is suitably connected to both the ventilator and the patient and that the patient circuit, including all hoses, is not damaged or obstructed. Users must always possess an additional breathing circuit and exhalation valve while using the Puritan Bennett™ 520 Ventilator. Verify the functionality of the alarm conditions before connecting the patient to the ventilator. Refer to chapter F, “Alarms Tests" Before starting ventilation, always verify that all settings are properly set in accordance with the required prescription. If the ventilator fails the alarm tests or if you cannot complete the tests, refer to chapter 5.8, “Troubleshooting” or call your equipment supplier or Covidien. Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged. To turn the ventilator on: • Set the I/O switch (a covered, rocker-type switch located at the rear of the ventilator) to the I position, as shown in Figure 7-1 below. Clinician’s Manual 7-1 Operating Procedures Figure 7-1. Turning on the Ventilator The following events occur: • The ventilator is powered on. • A Power On Self Test (POST) is carried out (when plugged in to an AC power source). • The front panel indicators flash (except for the indicator showing the type of power supply in use, which remains lit). • • • • The audible alarms briefly sound. The display’s backlight turns on. The PURITAN BENNETT logo is displayed momentarily. The blue VENT STDBY indicator to the right of the VENTILATION ON/OFF key illuminates, indicating the device is in standby mode. • A Welcome Menu screen is displayed for about five (5) seconds, which includes the machine hours counter and patient hours counter, as shown in Figure 7-2. Figure 7-2. Welcome Menu Screen Note: If the ventilator had been previously stopped by use of the I/O switch while ventilation was in progress, the ventilator starts directly in ventilation mode and does not show the Welcome Menu screen. The Alarm, Technical Fault, and Event logs are stored in non-volatile memory on the Main CPU PCB, ensuring that the information is retained when the ventilator is powered off and during power loss conditions. 7-2 Clinician’s Manual Setup Menu Parameters To skip the Welcome Menu: • Press VENTILATION ON/OFF to start ventilation immediately. The Ventilation menu is then displayed. Figure 7-3. Ventilation Menu Parameters By default, the starting ventilation mode is the last one used, the settings being those that were active when the machine was last stopped. If the ventilator’s memory of the settings is faulty, a “CHECK SETTINGS” alarm is activated. If this occurs, the desired parameters should be reset and saved; otherwise the machine will operate on default parameter values. 7.2 Setup Menu Parameters 7.2.1 Accessing Setup Configuration Note: The Locking Key prevents access to the Setup menu (refer to section 7.8, “Locking the Control Panel,” on page 727 and section 7.9, “Unlocking the Control Panel,” on page 7-27). The Setup menu cannot be accessed if the ventilator had been powered off, without first placing the device into standby. 1. Check the ventilator’s I/O switch is set to OFF (O) position. 2. Press and hold the ALARM CONTROL key while switching the I/O switch to ON (I). Hold the key until the Setup menu appears (approximately three seconds). Refer to Figure 7-4. Figure 7-4. Setup Menu 3. Release the ALARM CONTROL key. Clinician’s Manual 7-3 Operating Procedures 7.2.2 Changing the Setup Menu Parameters To change the Setup Menu settings: 1. Press UP or DOWN to position the cursor beside the parameter to be modified. 2. Press ENTER. • The cursor changes. • The selected parameter value flashes. 3. Press UP or DOWN to modify the value of the selected parameter. 4. Press ENTER to confirm the newly selected value. Note: When a parameter contains several setup fields (such as Date and Time) press ENTER to move from one field to the next. If you do not confirm a change by pressing ENTER before seven (7) seconds elapse, the ventilator restores the setup field’s previous value. The parameters in this menu are: • • • • • • • • • • • Machine Hours Language Date Time Intentional Vent Stop Cycling Mode Relative pressure Pressure Unit E Sens settings Patient Hours Maintenance Machine Hours: The counter records the total ventilation time in hours (to the nearest hour) since manufacture. Note: The machine hour meter is reset when the CPU board is changed. 7-4 Clinician’s Manual Setup Menu Parameters Language The language can be set here. All messages and denominations are automatically displayed in the selected language. The languages available are: Table 7-1. Languages English (US) Finnish Japanese English (UK) Russian Italian German Portuguese French Danish Polish Spanish Chinese Norwegian Swedish Turkish Dutch Korean Date The current date can be set here. The date is displayed in the format: DD MMM YYYY. Time The current time can be set here. The time is displayed in the format: HH: MM: SS. Intentional Vent Stop Alarm The Intentional Ventilation Stop Alarm is an alarm to warn that ventilation has been switched off by the user / caregiver and the ventilator is in stand-by. To set the Intentional Vent Stop Alarm: 1. Use the UP or DOWN arrows to place the cursor at the “Intentional Vent Stop” alarm position. 2. Press ENTER. 3. Press UP or DOWN to set the message to “YES”. Press ENTER. Cycling Mode The cycling mode determines the duration of inspiratory time in P A/C. It can be set to either I:E or I/T and enables the operator to set the duration of inspiratory and exhalation phases. The two cycling modes represent the relationship between inspiration time to exhalation time as follows: 1. I/T: Inspiratory time (Ti) as a percentage of the total breath cycle time (Ti + Te). I/T (%) = [Ti / (Ti+Te)] x 100 2. I:E The inspiration time (Ti) to exhalation time (Te) ratio. I:E = 1/(Te /Ti) In P A/Cmode, the cycling ratio changes based on patient inspiration; however, the inspiratory time remains constant and corresponds to the rate and cycling ratio settings. Note: When adjusting I:E or I/T ratio, the corresponding calculated Ti is displayed below the parameter zoom in the monitoring and information window. Clinician’s Manual 7-5 Operating Procedures Absolute and Relative Pressure The relative pressure for the inspiratory pressure setting (P Control and P Support) in PSV and P A/C, can be set to OFF or YES and allows the choice between setting the inspiratory pressure relative to PEEP or setting an absolute inspiratory pressure. The default value is absolute (ABS). If relative pressure is set to YES, the PEEP is added to the inspiratory pressure setting to determine the peak inspiratory pressure. If relative pressure is set to OFF, the inspiratory pressure setting will determine the peak inspiratory pressure regardless of the PEEP setting. Relative pressure = YES: Inspiratory pressure setting + PEEP = Peak Inspiratory pressure. Relative pressure = OFF (ABS): Inspiratory pressure setting = Peak Inspiratory pressure. The symbol ABS for absolute or REL for relative will be displayed at the top of the screen as follows: Figure 7-5. Absolute and Relative Pressure Pressure Unit The unit of pressure can be set here. It can be displayed as mbar, cmH20 or hPa. E Sens Settings E Sens enables the operator to adjust the sensitivity of the expiratory trigger in pressure support breaths in PSV mode which will cycle the breath into the expiratory phase. During a Pressure Support inspiration the delivered flow will reach a peak value and then begin to decelerate toward zero. The E Sens setting allows the operator to set the flow value, as a percentage of peak flow, that will cycle the breath to exhalation.The E Sens setting can be set to either POSITIVE or NEGATIVE. 7-6 Clinician’s Manual Setup Menu Parameters If set to POSITIVE, E Sens is based on the percentage of inspiratory peak flow. If set to NEGATIVE, E Sens is based on the percentage of inspiratory peak flow by which the flow must decrease before exhalation is declared. Insp Sec Exh Figure 7-6. E Sens Settings Patient Hours The value of this parameter is equal to the total number of hours that the patient has been ventilated. Note: Resetting the patient hours will also reset the trends stored in the device memory in preparation for a new patient. To reset the Patient Hours counter to zero: 1. Press DOWN to place the cursor at the “Patient Hours“ line, as shown in Figure 7-7. Figure 7-7. Resetting Patient Hours to Zero (1) 2. Press ENTER. • The cursor is placed on the “Reset Hours” line. 3. Press ENTER. • “OFF“ flashes. Clinician’s Manual 7-7 Operating Procedures 4. Press UP or DOWN to change the “OFF” message to “YES“, as shown in Figure 7-8: Figure 7-8. Resetting Patient Hours to Zero (2) 5. Press ENTER. • “YES“ is displayed continuously. • A long “beep“ sounds. • The patient counter display indicates 00000h, as shown in Figure 7-9: Figure 7-9. Resetting Patient Hours to Zero (3) 6. Press UP or DOWN. • The display indicates “Reset Hours: OFF“, as shown in Figure 7-10. Figure 7-10. Resetting Patient Hours to Zero (4) Maintenance This option is reserved for Service personnel qualified by Covidien to ensure correct maintenance and operation of the device. For information on using the Maintenance option, refer to the Puritan Bennett™ 520 Ventilator Service Manual. 7-8 Clinician’s Manual Preferences Menu Parameters 7.2.3 Exiting the Setup Screen To exit the SETUP Screen, you must cycle the ventilator’s power. 1. Set the ventilator’s rear panel I/O switch to OFF (O). Wait 30 seconds. 2. Turn the ventilator’s I/O switch ON (I). The ventilator will run through a Power On Self Test (POST) routine and then return to Standby mode. 7.3 Preferences Menu Parameters The Preferences menu is only accessible if the Locking Key has not been enabled (refer to section 7.8, “Locking the Control Panel,” on page 7-27 and section 7.9, “Unlocking the Control Panel,” on page 727). The Preferences menu is accessed from the Ventilation Parameters menu, when ventilation is either on or off. WARNING Setting Alarm limits to extreme values can cause the ventilator alarms to malfunction. Note: Default alarm setting preferences should be entered prior to using the ventilator. 7.3.1 Preferences Menu To display the Preferences menu: 1. Press DOWN several times, or continue to press DOWN, until the cursor is on the “Preferences” line, as shown in Figure 7-11: 2. Press ENTER. The Preferences menu is displayed. Figure 7-11. Selecting the Preferences Menu Clinician’s Manual 7-9 Operating Procedures Figure 7-12. Changing Settings in the Preferences Menu To change the settings in the Preferences menu: 1. Press UP to place the cursor on the parameter line to be modified. 2. Press ENTER. • The cursor changes to the plus/minus symbol. • The parameter selected to be modified flashes, or for certain parameters featuring a bar graph, the indicator triangle under the bar graph becomes filled. Refer to Figure 7-13. Cursor: plus/minus symbol Parameter value: flashing Indicator triangle: filled Figure 7-13. Modifying the Parameters 3. Press UP or DOWN to change the selected parameter’s value. 4. Press ENTER to confirm the new parameter setting. • The new parameter setting is displayed. • The cursor returns to its initial form. If a parameter change is not confirmed by pressing ENTER before seven (7) seconds elapse, the ventilator resets the parameter to its previous value. The parameters in this menu are: • • • • • • • • 7-10 Backlight Contrast Alarm Volume Key Sound Apnea Alarm Disconnection Alarm Pediatric Circuit Ventilation Report Clinician’s Manual Preferences Menu Parameters To adjust the various Preferences menu parameters, or to view the Ventilation Report, refer to the instructions provided in this section. To manually exit from the Preferences menu: • Press ENTER when the cursor is on “Back to Ventilation“. You will automatically exit from the Preferences menu when: • No keyboard action is detected before 15 seconds elapse, or • A High Priority alarm is triggered. 7.3.2 Backlight To set the Backlight: 1. Select the Backlight parameter on the display. 2. Set the backlight: a. To set the backlight to standby, select OFF. The effect of this setting is that if no keyboard action occurs before one minute elapses, the display’s backlight fades almost to off. The display will illuminate when the following occurs: • Any one of the keys on the keyboard is pressed • An alarm is triggered b. To set the backlight to light continuously, select YES. This setting ensures that the display is continuously lit. Note: If running the ventilator on its internal battery or on an external battery, Covidien recommends keeping the backlight setting to OFF to reduce power consumption. 3. Confirm the new Backlight setting before seven (7) seconds elapse. The default setting for Backlight is YES (backlight lit continuously). 7.3.3 Contrast To set the Contrast: 1. Select the Contrast parameter on the display. 2. Set the Contrast level: a. To increase the contrast, press UP. This change can be observed as the cursor moves to the right: Figure 7-14. Increasing the Contrast Clinician’s Manual 7-11 Operating Procedures • The display contrast progressively increases. b. To decrease the contrast, press DOWN. This change can be observed as the cursor moves to the left: Figure 7-15. Decreasing the Contrast • The display contrast progressively decreases. 3. Confirm the new Contrast setting by pressing ENTER before seven (7) seconds elapse. When ventilation is stopped, the contrast can also be changed directly from the currently displayed menu by pressing ALARM CONTROL continuously, while repeatedly pressing UP or DOWN. The default setting for Contrast is the medium setting (the middle of the bar graph). 7.3.4 Alarm Volume WARNING The sound level of the alarms should be adjusted according to the installation environment and the size of the area monitored by the patient’s caregiver. Ensure that the alarm sound apertures at the front of the device are never obstructed. See section 7.3.4 , “Alarm Volume,” on page 7-12. To set the Alarm Volume: 1. Select the Alarm Volume parameter on the display. See section 7.3.1 , ”Preferences Menu”. 2. Set the Alarm Volume level: a. To increase the sound level of alarms, press UP. This change can be observed as the cursor moves to the right: Figure 7-16. Increasing the Alarm Volume • The buzzer activates and increases in sound level as the setting increases. b. To decrease the sound level of alarms, press DOWN. This change can be observed as the cursor moves to the left: Figure 7-17. Decreasing the Alarm Volume • The buzzer activates and decreases in sound level as the setting decreases. 3. Confirm the new Alarm Volume setting before seven (7) seconds elapse. Current hospital standards require a minimum sound level of 55 dB (A) at a distance of 3 metres (9.84 feet), which corresponds to the lowest possible volume setting. The alarm sound level range is 65dB (A) to 85dB (A) measured at 1 metre (3.28 feet). If a high priority alarm is not paused within 60 seconds of activation, the sound level automatically raises to 85dB (A) regardless of the original setting. 7-12 Clinician’s Manual Preferences Menu Parameters The default setting for Alarm Volume corresponds to a level of 75dB (A). 7.3.5 Key Sound This setting is used to select the sound emitted when pressing keys on the ventilator’s keyboard. To set Key Sound: 1. Select the Key Sound parameter on the display. 2. Select one of the following four options: • • • • OFF – No sound is emitted when a key is pressed. Key tone – A “clock” sound is emitted when a key is pressed. Accept tone – A “beep” sounds when ENTER is pressed to confirm a setting. All tones on – A “clock” sound is emitted when all keys are pressed and a beep sounds when ENTER is pressed to confirm a setting. 3. Confirm the new Key Sound setting by pressing ENTER before seven (7) seconds elapse. The default setting for Key Sound is Accept tone. Note: Whatever the selected Key Sound setting, pressing the VENTILATION ON/OFF key triggers a “beep” at ventilation start and a double “beep“ at ventilation stop. 7.3.6 Apnea Alarm To set the Apnea Alarm: 1. Use the UP or DOWN arrow keys to place the cursor at the “Apnea Alarm” position. 2. Press ENTER. 3. Press UP or DOWN to set the message to “YES”. Setting the key to “OFF” means the Apnea Alarm will not sound when the ventilator is stopped. 4. Press ENTER. WARNING The Apnea Alarm should be set to YES if an audible alarm is desired when apnea events occur. Clinician’s Manual 7-13 Operating Procedures Figure 7-18. Setting the Apnea Alarm Note: This activates / disactivates the Apnea alarm but not the Apnea Time Setting. The Apnea Time Setting can be set in the Ventilation Menu. 7.3.7 Disconnection Alarm To set Disconnection Alarm: 1. Use the UP or DOWN arrow keys to place the cursor at the “Disconnection Alarm” position. 2. Press ENTER. 3. Press UP or DOWN arrows to adjust the setting between 5 and 62 seconds. 4. Press ENTER. Note: Values set in the ventilation mode may supercede disconnection alarm values. Refer to chapter 5, “Alarms and Troubleshooting". 7.3.8 Pediatric Circuit To choose a pediatric circuit: 1. Select the Pediatric Circuit parameter on the display. 2. Select either: • YES - Selects a pediatric patient circuit • OFF - Selects an adult patient circuit 3. Confirm the new patient circuit before seven (7) seconds elapse. To set up the ventilator for a pediatric circuit: 1. Use the UP or DOWN arrows to place the cursor at the “Pediatric Circuit” position. 2. Press ENTER. 3. Press UP or DOWN to set the message to “YES.” Setting the ventilator to “OFF” configures the device for an Adult circuit. 4. Press ENTER. Note: The default setting is “OFF” (the ventilator is set for Adult use). 7-14 Clinician’s Manual Setting the Ventilation Mode 7.3.9 Ventilation Report Accessing the Ventilation Report: 1. Use the UP or DOWN arrows to place the cursor at the “Ventilation Report” position. 2. Press ENTER. Figure 7-19. Accessing the Ventilation Report Note: The report is displayed for five minutes then screen reverts to the Preferences Menu. To exit the Ventilation report: 1. Press ENTER. 7.4 Setting the Ventilation Mode The ventilation mode can be changed from the ventilation parameters menu or the alarm parameters menu, as long as the Locking Key is not enabled (refer to section 7.8, “Locking the Control Panel,” on page 7-27, and section 7.9, “Unlocking the Control Panel,” on page 7-27). The procedure to change the ventilation mode depends on the ventilation status, as described in section 7.4.1 and section 7.4.2. WARNING The inspiration trigger threshold should be carefully modified in order to avoid the risk of false triggering or “autotriggering” of the ventilator. For example, Level 1P, the most sensitive mode, is recommended for pediatric use. However, for an adult, this setting may result in autotriggering. This ventilator offers a choice of breath delivery modes and types. Throughout the patient’s treatment, the clinician should carefully select the ventilation modes and/or breath type to use for that patient. This selection should be based on the clinician’s clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time, and considering the benefits, limitations and operating characteristics of each mode and/or breath type. Clinician’s Manual 7-15 Operating Procedures 7.4.1 Changing Modes While Ventilation is on Standby To change ventilation modes while on standby: 1. Place the cursor on the first line of the menu (general information line) using the UP key. Figure 7-20. Changing Ventilation Modes While on Standby 2. Press ENTER. • The cursor changes to: . • The mode name flashes. 3. Press UP or DOWN until the required mode is displayed. 4. Press ENTER to confirm the mode selected. • The cursor returns to normal. • The new mode is displayed with its ventilation parameters. If the ventilation mode change is not confirmed by pressing ENTER before seven (7) seconds elapse, the ventilator restores the previous mode. 7.4.2 Changing Modes During Ventilation WARNING When changing the mode during ventilation, significant transitions of pressure, flow or cycling rate might occur, depending on the difference between the modes. Before setting the new mode, first ensure that the settings between the different modes are compatible. This reduces the risk of discomfort and harm to the patient. 7-16 Clinician’s Manual Setting the Ventilation Mode Changing ventilation modes during ventilation: 1. Place the cursor on the first line of the menu (general information line) using the UP key (Figure 7-21). Figure 7-21. Changing Ventilation Modes During Ventilation 2. Press ENTER. • The cursor changes to: . • The mode name flashes. 3. Press UP or DOWN until the required mode is displayed. 4. Press ENTER to confirm the mode selected. • The name of the new mode selected is displayed at the top left followed by the flashing “INACTIVE“ status indicator (Figure 7-22, item 1). • The name of the mode in progress is displayed at the top right followed by the continuous “ACTIVE“ status indicator (Figure 7-22, item 2). • The settings for the new mode are displayed on the left (Figure 7-22, item 3) and the monitored values for the mode in progress on the right (Figure 7-22, item 4). • The confirmation line “Accept Mode:YES“ is displayed on the bottom left (Figure 7-22, item 5). 1 2 3 4 5 Figure 7-22. Displaying Active and Inactive Modes The Alarm menu screen is shown in Figure 7-23 shows the active and inactive mode information being displayed, along with the “Accept Mode:Yes” line, alarm parameter settings, and patient values. Clinician’s Manual 7-17 Operating Procedures Figure 7-23. Changing the Settings of the New Mode 5. Change the settings of the new mode, including alarms, if necessary. 6. Press DOWN to place the cursor on the “Accept Mode:YES“ line. 7. Press ENTER to confirm the mode change. • The new mode selected is displayed with its settings. It is applied at the beginning of the next exhalation phase if it occurs during inspiration or immediately if it occurs during exhalation. It is not mandatory to change modes during ventilation (see steps 6 and 7, above). The settings of the next (“INACTIVE“) mode can be “prepared” while ventilation is in progress in the current (“ACTIVE”) mode. The modifications will be saved for this next mode, whether or not it is used immediately afterwards. When setting the parameters of the future and currently inactive modes, the monitoring data for the mode in progress are displayed in the window to the right of the menu and also in the central (“Patient”) column of the table on the Alarm menu screen. When changing the value of a parameter in this inactive mode, the monitoring data displayed in the window on the right side of the screen are temporarily hidden by the display of the value currently being changed. This is shown in Figure 7-24, as the I Sens setting is adjusted in the inactive mode. Figure 7-24. Changing Ventilation Modes and Parameters If an alarm is triggered during the setting of an inactive mode, its message is displayed in the alarm message display. When the menu of an inactive mode is displayed and no changes are made by the user on the keyboard within 14 seconds, the display of the active ventilation mode in use reappears on the screen and the “Accept Mode:YES“ line disappears. The menu of the active mode can also be recalled without waiting for this delay by directly restoring the name of the mode on the general information line. The ventilation parameters of the inactive mode and the current mode remain in memory until some or all of the parameters are modified again; this is true even after the machine is stopped. 7-18 Clinician’s Manual Setting Ventilation Parameters 7.5 Setting Ventilation Parameters Ventilation parameters can be changed as long as the Locking Key is not activated (refer to section 7.9, “Unlocking the Control Panel,” on page 7-27). WARNING In adult or pediatric use ensure that the adjusted tidal volume is compatible with the needs of the patient. Ventilation is not interrupted by the adjustment of a value. It continues according to previous settings. The new settings are applied ONLY after they are confirmed and synchronised in the next breath cycle, except for the I Sens setting, which is applied immediately. To modify a ventilation parameter: 1. Place the cursor on the line of the parameter to be modified using the UP or DOWN key. 2. Validate your intention to modify the parameters using the ENTER button. Refer to Figure 7-25. • The cursor changes (Figure 7-25, item 1). • The parameter value flashes (Figure 7-25, item 2). • A zoom of the parameter value is displayed in the right-side of the window (Figure 7-25, item 3). 2 1 3 Figure 7-25. Modifying a Ventilation Parameter 3. Press UP or DOWN to select the value desired for the parameter (continuing to press on these keys speeds up the progression of values displayed). 4. Press ENTER to confirm the selected value. • The new parameter value is displayed continuously. • The zoom disappears. • The cursor returns to normal. Note: If a parameter change is not confirmed by pressing ENTER before seven (7) seconds elapse, the ventilator restores the parameter’s previous value. Clinician’s Manual 7-19 Operating Procedures 7.5.1 Links between Ventilation Parameters The adjustment ranges of certain parameters are limited in order to remain compatible with the levels of other previously set parameters. For additional information on the interdependence between ventilation parameters, refer to chapter 3, “Operating Parameters”. The message “Setting limited by...“ is displayed and identifies the parameter(s) that is (are) blocking the setting. Figure 7-26, item 1, shows that P Support cannot be set above 35 when PEEP is set to 20 and relative pressure is set to YES; this value is limited by PEEP because their sum cannot exceed 55 mbar. 1 2 Figure 7-26. Setting Links Between Ventilation Parameters Two possibilities exist in this case: • Allow the PEEP setting to remain at 20, but the P Support cannot be increased. • Reduce PEEP so that the P Support setting can be set higher than 35 to ensure that their sum is no greater than 55. 7.5.2 Links between Ventilation and Alarm Parameters Setting a ventilation parameter takes priority over an alarm threshold setting and leads to automatic readjustment of the alarm setting threshold so that the interdependence between the two remains unchanged. Once the ventilator is in service at the patient’s home, you should use the Locking Key to block access to changing any settings (see section 7.8, “Locking the Control Panel,” on page 7-27). WARNING Before dispensing the ventilator to caregivers or the patient for home use, ensure the Locking Key is activated so that critical ventilator settings are not modified. 7.6 Setting Alarm Parameters Alarm parameters can be changed from the Alarm menu, if the Locking Key is not enabled (refer to section 7.8, “Locking the Control Panel,” on page 7-27 and section 7.9, “Unlocking the Control Panel,” on page 7-27). Note: Adjustable alarms should not be systematically cancelled, they should be adjusted according to the needs and condition of the patient. Default alarm setting preferences should be entered prior to using the ventilator. 7-20 Clinician’s Manual Setting Alarm Parameters To modify an Alarm Parameter: 1. Ensure that the Alarm menu is displayed, showing a list of alarm parameters and columns for the minimum, current, and maximum alarm parameter values (Figure 7-27 on page 7-21). 2. Put the cursor next to the alarm parameter to be modified using the UP or DOWN key. 3. Confirm your intention to modify the parameters using the ENTER key. • The cursor changes. (Figure 7-27, item 1). • The parameter in the “Min“ column flashes (Figure 7-27, item 2). • A zoom of the Min parameter is displayed on the right side of the screen (Figure 7-27, item 3). 2 1 3 Figure 7-27. Modifying Alarm Parameters – Min Value 4. Press UP or DOWN to modify the value of the parameter. 5. Press ENTER to confirm the value selected. • The new value for the “Min“ column is continuously displayed (Figure 7-28, item 1). • The value of the “Max“ column flashes (Figure 7-28, item 2). • A zoom of the Max parameter value is displayed on the right side of the window (Figure 7-28, item 3). 1 2 3 Figure 7-28. Modifying Alarm Parameters – Max Value 6. Press UP or DOWN to modify the value of the parameter. Clinician’s Manual 7-21 Operating Procedures 7. Press ENTER to confirm the value selected. • The new value is continuously displayed. • The zoom disappears. • The cursor returns to normal. When an alarm is set to “OFF“ (the alarm will not be triggered) automatically when its maximum setting limit (for the Max value) or its minimum setting limit (for the Min value) is reached by successively or continuously pressing UP or DOWN respectively. If a parameter change is not confirmed by pressing ENTER before seven (7) seconds elapse, the ventilator restores the parameter’s previous value. Blocking of an Alarm Threshold Linked to a Ventilation Parameter Setting a ventilation parameter takes priority over an alarm threshold setting. Therefore, if a ventilation parameter is modified when linked to an alarm threshold, the alarm setting threshold is automatically adjusted so that the interdependences linking them are always maintained. However, if the alarm setting threshold is modified, it cannot be changed beyond the limit of the interdependence with the ventilation parameter to which it is linked. When the alarm setting limit is reached, the message “Setting limited by...“ indicates the name of the linked ventilation parameter(s) that are limiting the parameter’s setting value. For more information on the relationship between alarm setting limits and ventilation parameters, refer to chapter 7, “Operating Procedures”. Four possibilities exist in this case: • The alarm parameter remains set to “OFF“. • The alarm parameter setting is changed in relation to the value required at the start and the limits on the ventilation parameter(s) remain unchanged. • The setting of the ventilation parameter(s) is changed to enable the alarm threshold to be set to the required value. • The alarm parameter is not set to OFF but the ventilation parameter change has no impact on the alarm setting. WARNING The level of inspiratory resistance of the circuit and accessories (bacteria filter, humidifier) must be as low as possible. Settings—particularly the PATIENT DISCONNECTION alarm, maximum inspired volume (Max VTI), and minimum inspired volume (Min VTI) settings—must be periodically adjusted according to changes in the patient circuit resistance—especially when filters are replaced. Adjustable alarms should not be systematically cancelled; instead, they should be adjusted according to the needs and condition of the patient. 7.7 USB Menu Parameters The USB menu is accessible even if the Locking Key has been enabled (refer to section 7.8, “Locking the Control Panel,” on page 7-27 and section 7.9, “Unlocking the Control Panel,” on page 7-27). The USB menu is automatically displayed when the USB memory device is connected to the ventilator, when ventilation is either on or off. Only one USB memory device shall be connected at any time, otherwise an error message will be displayed. The USB Menu is not accessible from the Setup Menu or Maintenance menu. 7-22 Clinician’s Manual USB Menu Parameters To access patent data via a PC, a dedicated software package, Puritan Bennett™ Respiratory Insight Software, is available for Clinicians. Contact Covidien or your Puritan Bennett product representative for further information. 7.7.1 USB Memory Device Specifications Table 7-2. USB Memory Device Specifications Characteristics Supported Formats USB compatibility USB flash memory USB 2.0 or USB 1.1, 32 bit format Number of files Maximum 999 (sector size: 512-2,048 bytes) USB size 128 MB to 4GB (to guarantee accuracy of transfer time, at least 10% of the USB memory device capacity must be free). 7.7.2 USB Menu To access the USB menu when a USB memory device is connected: Press the MENU key several times, until the USB Menu appears: Figure 7-29. Selecting the USB Menu In case of high priority alarm activation the ventilator will automatically display the alarm page. To return to the USB Menu, press the MENU key. The adjustable parameters in this menu are: • Transfer continuously • Transfer trends • Erase key 7.7.3 Transfer Continuously Up to 48 hours worth of data can be transferred from a ventilator to a USB memory device. To record continuously, the USB memory device must be permanently connected to the ventilator with ventilation active. The following data will be recorded to the USB memory device: • Monitoring: pressure, leak waveforms and inspired flow • Trends: leaks, VTI, Rate, I:E, M. Vol, PIP and PEEP measurements. Clinician’s Manual 7-23 Operating Procedures The data can be accessed by a doctor or service provider using the Puritan Bennett™ Respiratory Insight Software. Figure 7-30. Selecting Transfer Continuously To transfer continuous data from a ventilator to a USB memory device: 1. Use the UP or DOWN arrow keys to place the cursor at the “Transfer Continuously” position. 2. Press ENTER. • The cursor changes to the plus/minus symbol. • The parameter selected to be modified flashes. 3. Press UP or DOWN to change the selected parameter’s value. 4. Press ENTER to confirm the new parameter setting. • The new parameter setting is displayed continuously. • The cursor is placed at the STOP position. 5. To manually stop continuous transfer, press the ENTER key. If a parameter change is not confirmed by pressing ENTER before seven (7) seconds elapse, the ventilator resets the parameter to its previous value. Note: All ventilator menus remain accessible during transfer time. The message “TRANSFER IN PROGRESS... REMAINING TIME” is displayed during the transfer time. Other functions of the USB memory device are not available during continuous recording. If the memory capacity on the USB memory device is insufficient the message “TRANSFER NOT ALLOWED - USB CAPACITY INSUFFICIENT” is displayed and data transfer is not allowed. Delete the data on the USB memory device before restarting data transfer. Refer to deletion process (section 7.7.5 , “Erase Data from the USB Memory Device”). In case of USB memory device disconnection or transfer error, the message “TRANSFER ERROR - USB DISCONNECTION” or “TRANSFER ERROR - TECHNICAL PROBLEM” is displayed. In this case restart the transfer process. If the problem persists contact your technical service representative. 7.7.4 Transfer Trends Up to one year’s worth of trend data can be transferred from a ventilator to a USB memory device. Ventilation trends such as leaks, VTI, Rate, I:E, M. Vol, PIP and PEEP measurements can be transferred from the ventilator to a USB memory device. 7-24 Clinician’s Manual USB Menu Parameters The data can be accessed by a doctor or service provider using the Puritan Bennett™ Respiratory Insight Software. Figure 7-31. Selecting Transfer Trends To transfer trend data from a ventilator to a USB memory device: 1. Use the UP or DOWN arrow keys to place the cursor at the “Transfer Trends” position. 2. Press ENTER. • The cursor changes to the plus/minus symbol. • The parameter selected to be modified flashes. 3. Press UP or DOWN to change the selected parameter’s value. 4. Press ENTER to confirm the new parameter setting. • The new parameter setting is displayed continuously. • The cursor is placed at the STOP position. 5. To manually stop trend transfer, press ENTER. If a parameter change is not confirmed by pressing ENTER before seven (7) seconds elapse, the ventilator resets the parameter to its previous value. Table 7-3. Trends Data Transfer Time from Ventilator to USB Memory Device Amount of trends data (in months) Transfer time from ventilator to USB memory device 3 months Approximately 2 minutes 6 months Approximately 4 minutes 9 months Approximately 6 minutes 12 months Approximately 8 minutes Note: The message “TRANSFER IN PROGRESS... REMAINING TIME” is displayed during the transfer time. Other USB memory device functions are available during transfer of trends. Clinician’s Manual 7-25 Operating Procedures If the memory capacity on the USB memory device is insufficient the message “TRANSFER NOT ALLOWED - USB CAPACITY INSUFFICIENT” is displayed and data transfer is not allowed. Delete the data on the USB memory device before restarting data transfer. Refer to deletion process (section 7.7.5 , “Erase Data from the USB Memory Device”). In case of USB memory device disconnection or transfer error, the message “TRANSFER ERROR - USB DISCONNECTION” or “TRANSFER ERROR - TECHNICAL PROBLEM” is displayed. In this case restart the transfer process. If the problem persists contact your technical service representative. 7.7.5 Erase Data from the USB Memory Device To erase data from the USB memory device: 1. Use the UP or DOWN arrow keys to place the cursor at the “Erase key” position. 2. Press ENTER. • The cursor changes to the plus/minus symbol. • The parameter selected to be modified flashes. 3. Press UP or DOWN to change the selected parameter’s value. 4. Press ENTER to confirm the new parameter setting. • The new parameter setting is displayed continuously. • The cursor is placed at the STOP position. Figure 7-32. Erasing Data from the USB Memory Device WARNING Deletion erases ALL files present on the USB memory device. Note: The message “ERASE IN PROGRESS... REMAINING TIME” is displayed during the deletion time. The deletion time of a full USB memory device is less than one minute. Other USB memory device functions are not available during deletion. Once deletion of the USB memory device has been started, it cannot be paused, stopped or cancelled. 7-26 Clinician’s Manual Locking the Control Panel All ventilator menus remain accessible during deletion. In case of USB memory device disconnection or deletion error, the message “TRANSFER ERROR - USB DISCONNECTION” or “ERASE ERROR - TECHNICAL PROBLEM” is displayed. In this case restart the transfer process. If the problem persists contact your technical service representative. 7.8 Locking the Control Panel When the machine is in service at a patient’s home, it is strongly recommended that you prevent accidental or unauthorised ventilator adjustments from occurring by enabling the Locking Key. The Locking Key is a software function that prohibits access to the ventilation and alarm parameter settings and changes to the ventilation mode. WARNING Before dispensing the ventilator to caregivers or the patient for home use, ensure the Locking Key is activated so that critical ventilator settings are not modified. To enable the Locking Key: Simultaneously press the UP and the DOWN keys for at least six (6) seconds. • The Locking Key symbol (Figure 7-33, item 1) appears in the top left corner of the screen. • Lines which are no longer accessible are preceded by a dash “–“ (Figure 7-33, item 2). • Lines which remain operational keep their initial line access symbol. 1 2 Figure 7-33. Enabling the Locking Key 7.9 Unlocking the Control Panel To disable the Locking Key: Simultaneously press the UP and the DOWN keys for at least six (6) seconds. • The Locking Key symbol disappears. • The initial line access symbol is displayed in front of each line. Clinician’s Manual 7-27 Operating Procedures 7.10 Starting Ventilation Before starting ventilation, refer to Appendix E, “Operational Verification Checklist”, and set the parameter values in the Preferences menu (refer to section 7.3, “Preferences Menu Parameters,” on page 7-9). WARNING Verify the functionality of the alarm conditions before connecting the patient to the ventilator. Before starting ventilation, ensure that the device is properly assembled and that the air inlet, cooling vents, and alarm sound diffusion holes are not obstructed. Ensure also that the patient circuit is of the proper configuration, properly connected to the ventilator, and that the circuit hoses are neither damaged nor compressed and contain no obstructions or foreign bodies. When the ventilator is in standby (the ventilator is on, but ventilation has not started), a message that prompts the ventilator operator to press VENTILATION ON/OFF to start ventilation is displayed in the right-hand window of the ventilation and alarm menus (Figure 7-34). Figure 7-34. Prompt to Start Ventilation To start ventilation: Press and release VENTILATION ON/OFF (Figure 7-35, item 1). • The blue light indicator, at the upper right of the VENTILATION ON/OFF key (Figure 7-35, item 2), turns off. • A “beep“ sounds. • The ventilation starts. • The values of the monitored parameters are displayed in the right-hand window. 7-28 Clinician’s Manual Stopping Ventilation Figure 7-35. Starting Ventilation 7.11 Stopping Ventilation WARNING Do not allow a patient to remain connected to the ventilator when ventilation is stopped, because a substantial quantity of expiratory gas, primarily carbon dioxide, may be inhaled by the patient. In some circumstances, inhaling carbon dioxide may lead to under-ventilation, suffocation, and serious injury or death. You can stop your ventilator at any time. To stop the ventilator: 1. Press and hold the VENTILATION ON/OFF key (Figure 7-35, item 1) for three (3) seconds. • A message prompting the user to keep the button pressed appears on the monitoring window, as shown in the graphic below: Figure 7-36. Stopping Ventilation (1) 2. While keeping the VENTILATION ON/OFF key pressed: Clinician’s Manual 7-29 • A new message appears that directs the user to press the key again to confirm ventilation stop as shown in the following graphic). Figure 7-37. Stopping Ventilation (2) • A double “beep“ sounds. 3. Release the VENTILATION ON/OFF key. • Press the VENTILATION ON/OFF key within 5 seconds to confirm stop, otherwise ventilation will continue. • Ventilation stops. • The blue LED located to the upper-right of the VENTILATION ON/OFF key (Figure 7-35, item 2) illuminates to indicate ventilation is on Standby. • A prompt for a new start of ventilation is displayed (see Figure 7-34 on page 7-28). 7.12 Turning Off the Ventilator WARNING When the ventilator is switched back on, it will immediately begin ventilating—without the user first having to press the VENTILATION ON/OFF key. Handle the ventilator with care after use, particularly when ambient temperatures are high. Some ventilator surfaces may be very hot, even if safety specifications are not exceeded. Set the I/O switch to the O position to power off the ventilator. • The blue LED to the right of the VENTILATION ON/OFF key turns off. • The ventilator screen switches off. Note: When the ventilator is completely stopped, but is still connected to the AC power source (the green AC POWER indicator is illuminated), the internal battery continues charging. A continuous alarm condition will be activated if the ventilator power switch is turned off while ventilation is in progress. When the power switch is turned back on again, the ventilation will resume without having to press the VENTILATION ON/OFF button. Battery Capacity 8 Internal Battery WARNING Even though the Puritan Bennett™ 520 Ventilator meets current safety standards, and although the internal Lithium-ion battery of the device is considered to be Dangerous Goods for transport in commerce, this devices lithium battery is below the 100Wh threshold and is therefore excepted from being a Class 9 – Miscellaneous - Dangerous Goods (DG). As such, the Puritan Bennett™ 520 Ventilator and/or the associated Lithium-ion battery are subject to some transport conditions under the Dangerous Goods Regulation for air transport (IATA: International Air Transport Association), International Maritime Dangerous Goods code for sea and the European Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) for Europe. Private individuals who transport the device are excluded from these regulations although for air transport some requirements apply. For air transport; the Puritan Bennett™ 520 Ventilator is permitted as checked-in or carry-on baggage. Spare batteries may be taken on board as carry-on luggage only. This classification and regulatory requirements may vary depending upon the country and mode of transport. Therefore it is recommended that users verify with the carrier / airline as to which measures to take before the voyage. Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12– 30 VDC power source (via the DC power cable) does not enable charging of its internal battery. The maximum recommended shelf life of the internal battery is two (2) years. Do not use a battery that has been stored for two years or more prior to its first use. Periodic recharging is important to help maximise useful life of the battery. Do not store the internal battery for extended periods, without recharging, as this may reduce the maximum life. 8.1 Battery Capacity The reserve capacity offered by the internal battery depends on the level of ventilation parameters, the environmental conditions (primarily in terms of temperature) and the physiological characteristics of the patient. With a fully charged battery at a normal room temperature of 25 ºC (± 5 ºC), the ventilator can be expected to operate on internal battery power for the average durations shown in Table 8-1. Checking the battery charge level requires that the ventilator be running on battery power at the time of the battery check. To check the battery charge level, temporarily disconnect the ventilator from AC power (while in Stand By mode or while providing ventilation) and read the percent charge level displayed adjacent to the battery icon displayed at the top of the ventilator's display screen. Table 8-1. Internal Battery Reserve Capacity Displayed Values Average Operating Time on Internal Battery Powera Vt 200 ml (± 5 ml) PIP 10 mbar (± 2 mbar) 5 hours (–10%) Rtot 20 bpm Vt300ml (± 5 ml) PIP 20 mbar (± 2 mbar) 4 hours (–10%) Rtot 15 bpm Clinician’s Manual 8-1 Internal Battery Table 8-1. Internal Battery Reserve Capacity (Continued) Average Operating Time on Internal Battery Powera Displayed Values Vt500 ml (± 5 ml) PIP 30 mbar (± 2 mbar) 3 hours (–10%) Rtot 15 bpm Vt750 ml (± 5 ml) PIP 45 mbar (± 2 mbar) 2 hours (–10%) Rtot 20 bpm (Maximum Ventilation Parameters) a. Average durations shown are with a fully charged battery having less than 50 charge/recharge cycles. 8.2 Battery Operation WARNING Before using the ventilator’s internal battery, ensure that the battery is fully charged and that the charge holds. Back up ventilators or those in storage should be connected to an AC power source to protect the integrity of the battery. Note: Buzzer and battery alarms may occur when the unit is first powered on after the internal battery has been completely drained. Connect to an AC power source and recycle power. In the event of AC power interruption or disconnection of the external AC or DC power supply, the ventilator automatically switches to its internal battery and the following events occur: • The battery symbol is displayed at the top on the general information line. • Battery reserve capacity is displayed on the right of the battery symbol. • The internal battery indicator at the top left of the ventilator’s front panel is continuously lit (Figure 8-1). Figure 8-1. Internal Battery Indicator • A loss of external supply alarm is activated. 8-2 Clinician’s Manual Battery Operation If ventilation is stopped, the internal battery reserve capacity is displayed as a percentage of battery charge. Refer to Figure 8-2. Figure 8-2. Battery Reserve Capacity as a Percentage If the ventilator is running, the internal battery reserve is momentarily displayed as a percentage. Then, after the ventilator calculates the battery time remaining (which takes about two minutes, depending on the power consumption of the ventilator), the internal battery reserve is then displayed in hours and minutes (rounded to the nearest fifteen minutes). Refer to Figure 8-3. Figure 8-3. Battery Reserve Capacity in Hours and Minutes The “LOW BATTERY“ and “EMPTY BATTERY“ alarms (refer to chapter 5, “Alarms and Troubleshooting”) are triggered when the internal battery reserve is reduced. WARNING Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged. When the “LOW BATTERY“ alarm is triggered, immediately connect the ventilator to an AC power supply to maintain ventilation and recharge the internal battery. From the time that an “EMPTY BATTERY“ alarm is activated, if no external supply is connected to the ventilator, other alarms may be triggered due to insufficient supply voltage. In the final discharge phase, the “EMPTY BATTERY” alarm will become continuous, and ventilation may be interrupted at any time during this phase. Note: The “EMPTY BATTERY” alarm symbol may disappear shortly before the ventilator completely stops, but it always triggers a final, continuous alarm. Clinician’s Manual 8-3 Internal Battery 8.3 Testing the Battery Your ventilator continuously and automatically checks the state of the internal battery, even when the battery is not used as the main source of energy. The “BATTERY FAULT1“ alarm is activated whenever a problem is detected in the battery or the charger. However, on a monthly basis you should disconnect the ventilator from the external power supply to check the integrity of the connections linking the internal battery to other ventilator components. 8.4 Recharging the Battery In the event that the battery charge level is considered insufficient, as per the reserve capacity display, recharge of the internal battery is necessary. In general, it is recommended that the ventilator be allowed to charge when the battery drops below 80%, and that the ventilator be recharged systematically after storage and before using it again. Note: To avoid cycling and extend battery life while connected to an AC power source, the battery will not begin charging until it has dropped below an 85%-90% charge. To charge the internal battery, do the following: Connect the ventilator to the AC power source. • The “AC POWER” indicator illuminates (Figure 8-4, item 1). • The “INTERNAL BATTERY“ indicator flashes (Figure 8-4, item 2). 1 2 Figure 8-4. Power Indicators When Charging the Battery When the battery charge is complete, the “INTERNAL BATTERY“ indicator turns off. WARNING Even if the “INTERNAL BATTERY“ indicator is off, charge of the battery may sometimes be incomplete regardless of charge time when the ambient temperature is above 40 °C (104 °F). This is due to the characteristics of the battery’s internal heat safety device. Although it is not necessary to start the ventilator to charge the battery, charging the battery duringoperation will increase the time required to fully charge the internal battery. When recharging a depleted internal battery, it may be necessary to leave the ventilator on charge for up to six (6) hours if the ventilator is on standby and about 13 hours if ventilation is operating. 8-4 Clinician’s Manual Storage WARNING Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12–30 VDC power source (via the DC power cable) does not enable charging of its internal battery. 8.5 Storage If the ventilator is to be stored for an extended period of time, it is not necessary to remove the battery. However, the ventilator should be stored in cool, dry, well-ventilated environment, as follows: • Temperature: approximately 21 °C (70 °F) • Humidity: less than 80% RH Note: When the device is in storage it should be recharged monthly to maximise battery life. If the battery is stored for more than one month at a temperature greater than 21 °C (70 °F), or for more than one or two weeks at a temperature greater than 45 °C (113 °F), the reserve capacity of the battery may be affected. It will then be necessary to recharge the battery before using it again. If the ventilator has been in storage for longer than 30 days, connect it to an AC power source, turn on the unit by the I/O switch at the rear of the ventilator, and let it charge for 15 minutes prior to starting ventilation. The battery should not be stored for more than two years, whatever the conditions. Note: Fully charge the internal battery prior to disconnecting from AC Power source (“mains”). Clinician’s Manual 8-5 Internal Battery This page intentionally blank 8-6 Clinician’s Manual Cleaning the Ventilator 9 Cleaning WARNING A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection. To reduce the risk of infection, wash your hands thoroughly before and after handling the ventilator or its accessories. 9.1 Cleaning the Ventilator Clean all external panels and surfaces before and after each patient use and as often as necessary to keep the ventilator clean. You should clean the ventilator periodically, whenever it is soiled or dirty, before any maintenance operation, and before storing the ventilator. WARNING Use all cleaning solutions and products with caution. Read and follow the instructions associated with the cleaning solutions you use to clean your ventilator. Use only those solutions listed in Table 9-1. The ventilator should never be immersed in any liquid, and any liquid on the surface of the device should be wiped away immediately. To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator. To clean the surface of the ventilator: 1. Dip a clean, soft cloth into a mixture of mild soap and water, or other approvedcleaning solution. Refer to Table 9-1 for a list of approved cleaning solutions. 2. Squeeze the cloth thoroughly to remove excess liquid. 3. Lightly wipe the external casing of the ventilator, taking care not to allow excess moisture to enter any of the openings on the ventilator’s surface. See the warning, above. 4. Dry the ventilator surface with a clean, soft, lint-free cloth. Table 9-1. Approved Cleaning Solutions for Exterior Ventilator Surfaces Description Mild dishwashing detergent 70% isopropyl alcohol (rubbing alcohol) 10% chlorine bleach (90% tap water) Glutaraldehyde Hospital disinfectant cleaners Clinician’s Manual 9-1 Cleaning Table 9-1. Approved Cleaning Solutions for Exterior Ventilator Surfaces (Continued) Description Hydrogen peroxide 15% ammonia (85% tap water) Ammonia-based household cleaners Household cleaners 9.2 Cleaning the Accessories Follow the accessory manufacturer’s instructions for cleaning the ventilator’s accessories and components, including the patient circuit. WARNING After assembling, cleaning, or reassembling the patient circuit, and on a daily basis, inspect the hoses and other components to ensure that there are no cracks or leaks and that all connections are secure. Never use a liquid cleaner inside the patient circuit, or on any component of a gas pathway. Clean the patient circuit only as specified by the manufacturer's instructions. 9.3 Cleaning the Ventilator Between Patients To prepare the ventilator for use with a new patient, do the following: 5. Change the patient circuit and all filters. 6. Clean the ventilator. (See section 9.1, ‘Cleaning the Ventilator”) 9-2 Clinician’s Manual Replacing the Air Inlet Filter 10 Routine Maintenance WARNING On a DAILY basis, inspect the patient circuit to ensure that it shows no signs of damage, is properly connected, and is operating correctly without leakage. Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only personnel authorised and qualified by Covidien should repair, open or service the ventilator. 10.1 Replacing the Air Inlet Filter WARNING Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over. This is particularly important when the ventilator is installed on a wheelchair, because environmental conditions may cause the filter to become dirty more rapidly. Failing to replace a dirty air inlet filter, or operating the ventilator without a filter, may cause serious damage to the ventilator. The air inlet filter is for use on a single patient. It is not reusable; do not attempt to wash, clean, or reuse it. If the ventilator is used indoors, the condition of the air inlet filter should be checked monthly. If the ventilator is used outdoors or in a dusty environment, the air inlet filter should be checked weekly and replaced as necessary. To replace the air inlet filter: 1. Hold the filter between your fingers (see Figure 10-1, item 1). 2. Remove the filter (Figure 10-1, item 2) and discard it. 3. Place the new filter in the device, while ensuring that: a. The fine particle side of the filter faces outwards, away from the ventilator. b. The filter is properly installed in its housing. Proper installation of the filter prevents particles from entering the device. Clinician’s Manual 10-1 Routine Maintenance 1 1 Figure 10-1. Replacing the Air Inlet Filter 10.2 Recommended Schedule of Maintenance Consumables and Replacement Intervals When used under normal circumstances - a relatively dust-free atmosphere, and without damage to the device and its components (shocks, cracks, significant dirt) - the intervals for replacing the ventilator’s consumable elements are as follows: Table 10-1. Consumables and Replacement Intervals Elements Air Inlet Filter (Foam + Fine Particle) Inspiratory Bacteria Filter Patient Circuit Recommended Replacement Intervals Once a month or more often, depending on the extent of soiling See manufacturer’s recommendation See manufacturer’s recommendation Single use Single patient Note: For a list of parts and accessories, refer to Appendix H, “Parts and Accessories” or contact your service representative or consult http://www.respiratorysolutions.covidien.com. For all additional accessories not necessarily considered as consumables consult the manufacturer’s recommendations. To prevent any risk of cross contamination Covidien recommends the use of STERIVENT filters (Ref: 351/5856 or equivalent) to protect the patient outlet port. WARNING Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. Replace it when necessary— even before the recommended replacement period has elapsed, and particularly when the ventilator is installed on the wheelchair. Environmental conditions may cause the filter to become dirty more rapidly. Failure to observe these recommendations may result in a loss of performance, excessive overheating, a loss of certain functions and, in the long term, compromise the longevity of the ventilator. 10-2 Clinician’s Manual Service Assistance Maintenance of the Internal Battery The internal battery does not need to be removed to verify its correct operation. Periodic Test of the Internal Battery Your ventilator continuously and automatically checks the state of the internal battery, even when the internal battery is not used as the main power source. However, the battery charge status should be checked MONTHLY by disconnecting the ventilator from external power supplies (refer to section 8.2, “Battery Operation”). Such a test is imperative after opening the ventilator or after a prolonged period of non-use (one month or more), in order to ensure the correct operation of internal connections linking the battery to other components. WARNING The maximum recommended shelf life of the internal battery is two (2) years. Do not use a battery that has been stored for two years or more prior to its first use. Periodic recharging is important to help maximise useful life of the battery. Do not store the internal battery for extended periods, without recharging, as this may reduce the maximum life. Replacement of the Internal Battery The internal battery should be replaced when the battery capacity drops below 1920 mAh. Keep in mind that, for environmental protection, the ventilator and its components—including its internal battery—cannot be disposed of with household waste. You must submit the ventilator and its components for suitable selective collection and possible recycling and observe all applicable regulations. Note: As the total number of battery charge/discharge cycles approaches 300, a drop in potential of as much as 20% may be detected. 10.3 Service Assistance WARNING If a problem with the ventilator is suspected, FIRST CHECK THAT THE PATIENT IS NOT IN DANGER. If necessary, remove the patient from the ventilator and provide an alternative means of ventilation. Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only qualified service personnel should open, repair or service the ventilator. In the event of a problem with the ventilator, refer to chapter 5, “Alarms and Troubleshooting”. If you cannot determine the cause of the problem, contact your equipment supplier or Covidien. For more information and local Covidien Technical Service Contact details, refer to chapter , “Technical Support” in Preface chapter. Clinician’s Manual 10-3 Routine Maintenance This page intentionally blank 10-4 Clinician’s Manual A Patient/Caregiver Checklist What the Patient and Caregiver Must Understand Table A-1 presents a summary of the topics that patients and caregivers must understand in order to use the ventilator successfully. Some topics may not apply to some patients, while other patients may require additional information. The Clinician’s Responsibility It is the responsibility of the clinician or clinical educator to ensure that both the patient and the caregiver fully understand the topics listed below. Table A-1. Patient/Caregiver Checklist Clinician’s Manual List of Topics References Need for ventilation. Clinician Intended use of the ventilator. Chapter 2, ”Ventilator Overview” The principles of operation for the ventilator. Appendix C, “Theory of Operation” Supplies required for ventilation, and their sources. Clinician; Appendix G, “Unpacking and Preparation”; Appendix H, “Parts and Accessories” Schedule for ventilation. Clinician How and why to monitor the patient’s condition. Clinician The importance of coordinating care for the patient. Clinician Resources for respite care. Clinician Choices about future care. Clinician The purpose of advanced directives. Clinician How to check the patient’s vital signs. Clinician The significance of the patient’s ease of breathing. Clinician What to note about the patient’s skin, mucus membranes, and secretions, and their significance. Clinician How to recognise the signs of infection, and how to respond. Clinician Whom to contact for medical emergencies, equipment emergencies, or power emergencies. Clinician; section 5.8, “Troubleshooting”; section 10.3, “Service Assistance” Equipment and phone numbers to have available in cases of emergency. Clinician; Section 10.3, ”Service Assistance” A-1 Patient/Caregiver Checklist Table A-1. Patient/Caregiver Checklist (Continued) A-2 List of Topics References How to contact other resources for assistance (health aides, attendants, therapists). Clinician The importance of routine medical appointments and medical testing. Clinician Power sources for the ventilator and how to connect them. Section 6.2, ”Connecting to External AC Power” and section 6.3, “Connecting to an External DC Power Source” The meaning of keys and buttons. Section 2.7, ”Control Panel” The meaning of symbols and markings. Section 1.3, ”Symbols and Markings” How to connect the patient to the ventilator via the patient breathing circuit. Section 6.4, ”Patient Circuit” The parts and purpose of the breathing circuit. Chapter 6, ”Installation and Assembly” How and when to inspect, clean, and replace the patient circuit. Chapter 1, ”Safety Information”; Chapter 9, ”Cleaning”; Section 10.2, ”Recommended Schedule of Maintenance” How to recognise and respond to problems with the breathing circuit. Chapter 5, ”Alarms and Troubleshooting” The parts and purpose of the nasal interface or mask. Clinician or manufacturer’s instructions for use. Care of the nasal interface or mask. Clinician or manufacturer’s instructions for use. How to recognise and respond to problems with the nasal interface or mask. Clinician or manufacturer’s instructions for use. How to install the humidifier. Section 6.6, ”Humidifier” How to perform alarms tests, and how to respond if the alarms tests fail. Appendix F, “Alarms Tests”; Chapter 5, ”Alarms and Troubleshooting” Replacement interval for outlet filters (per the filter manufacturer’s instructions). Section 10.2, ”Recommended Schedule of Maintenance” Setting ventilation parameters and the importance of each. Chapter 3, ”Operating Parameters” Ventilator alarm settings; understanding the purpose and function of each. Section 5.7, ”Overview of Alarms” Recognising alarm priority level. Section 5.1, ”Alarm Level of Priority” What to do in case of ventilator alarms and problems. Chapter 5, ”Alarms and Troubleshooting” What to do if the ventilator alarms inappropriately. Section 5.8, ”Troubleshooting” The oxygen setting, and why it is required. Clinician How to connect the oxygen source to the ventilator. Clinician; section 6.7.1 , ”Administering Oxygen” Clinician’s Manual Table A-1. Patient/Caregiver Checklist (Continued) Clinician’s Manual List of Topics References How to determine the quantity of oxygen being delivered, and how to adjust the quantity. Clinician; section 6.7.1 , ”Administering Oxygen” Safety rules for the use of oxygen. Chapter 1, ”Safety Information”; section 6.7.1 , ”Administering Oxygen” How to recognise and respond to problems with the oxygen supply. Clinician How to respond to dyspnea. Clinician Techniques to prevent aspiration of vomit. Clinician A-3 Patient/Caregiver Checklist This page intentionally blank A-4 Clinician’s Manual Physical B Specifications B.1 Physical Table B-1. Physical Description (Excluding Accessories) Ventilator Weight 9.9 lb. (4.5 kg) Ventilator Dimensions 9.25 in wide x 12.40 in deep x 6.0 in high (235 mm wide x 315 mm deep x 154 mm high) Connectors Inspiratory limb connector: ISO 22 mm (OD) conical Oxygen inlet: Female Connector with valve Device airway volume 2000 ml Breathing circuit volume • • Adult, single limb 550 ml Pediatric, single limb 300 ml Air Inlet Filter Dimensions: 70 mm long x 60 mm wide Composition: Polypropylene fiber electrostatic filter material, which is laminated onto polyurethane open-celled foam. Efficiency: 99.999982% at 30 Lpm (filtering microbes 3.3 μm) Inspiratory Bacteria Filter Requirement B.2 Maximum allowable flow resistance: 4mbar at 60 lpm Electrical Table B-2. AC Electrical Supply Voltage Frequency Consumption 100 VAC to 240 VAC 50 Hz / 60 Hz 180 VA max 12 VDC NA 8.3 A 30 VDC NA 3.3 A Table B-3. Internal Lithium Ion Battery Voltage 25.2 VDC Full-load capacity 2.4 Ah Ampere-hour rating On standby: 1.5 Ah During ventilation: 0.5 Ah Watt hour rating 62Wh to 63Wh Charging current • • Clinician’s Manual Standby mode Ventilation mode 1.5 A/hr. (duration: < 4 hr.) 0.5 A/hr. (duration: < 8 hr.) B-1 Specifications Table B-3. Internal Lithium Ion Battery (Continued) Average operating time at 25 °C (± 5 ºC) with a fully charged battery (having less than 50 charge/discharge cycles) at the following displayed values: Vt = 200 ml (± 5 ml), PIP = 10 mbar (± 2 mbar), Rtot = 20 bpm 5 hr. (–10%) Vt = 300 ml (± 5 ml), PIP = 20 mbar (± 2 mbar), Rtot = 15 bpm 4 hr. (–10%) Vt = 500 ml (± 5 ml), PIP = 30 mbar (± 2 mbar), Rtot = 15 bpm 3 hr. (–10%) Vt = 750 ml (± 5 ml), PIP = 45 mbar (± 2 mbar), Rtot = 20 bpm 2 hr. (–10%) (maximum settings) Table B-4. Remote Alarm Remote Alarm Port: 4 Also known as the Nurse’s Call port, it provides for remote alerts of ventilator alarm conditions. 3 5 1 7 2 An example of a setting that requires such a feature is when the ventilator is used in an isolation room. 6 8 Nurse call pin-out (view from back of ventilator) The ventilator signals an alarm using a normally open (NO) or a normally closed (NC) signal. A remote alarm is activated when an alarm condition occurs, unless either of the following is true: • • Audio paused function is active Ventilator power switch is turned off The remote alarm port is an 8-pin female connector. Allowable current is 100 mA at 24 VDC (maximum). B-2 Pin Signal Remote Alarm Wire color 1 relay common black 2 normally open (NO) brown 3 normally closed (NC) orange 4 remote supply - (not used) 5 RX Signal (not used) 6 TX Signal (not used) 7 remote supply + (not used) Clinician’s Manual Indicators and Alarms B.3 Indicators and Alarms Table B-5. Power Indicators Ventilation ON/OFF AC power DC power Internal Battery • • Green Green • Blue in standby mode Not lit if ventilation is in progress. • Flashing if the battery charge is in progress. Continuously lit if the ventilator is powered by the internal battery. Table B-6. Alarm Indicators High Priority Medium Priority Red flashing LED Yellow flashing LED Table B-7. Audio Alarms B.4 Audio Paused Alarm Volume 60 s ± 1 s 65 to 85 dB (A) ± 10% at 1 meter Performance B.4.1 Specifications Table B-8. Performance Parameter Specifications and Tolerances B.5 Settings Range Tolerances Pressure 5 to 55 mbar ± (1 mbar +10%) Time 0.3 to 2.4 s ± 50 ms or 10%, whichever is greater Rate 1 to 60 bpm ± 1 bpm Inspiratory Sensitivity 1P to 5 N/A Exhalation Sensitivity 5 to 95% ± (4 lpm +10%) of target exhalation flow based on E Sens within 50ms I:E 1:4 to 1:1 ± 50 ms or 10%, whichever is greater I/T 20% to 50% ± 50 ms or 10%, whichever is greater Monitored Parameters Table B-9. Monitored Parameter Tolerances Ventilator Parameters Tolerances Peak Inspiratory Pressure (PIP) ± (2 mbar + 8%) a Positive End Expiratory Pressure (PEEP) ± (2 mbar + 8%) Inspiratory Tidal Volume (VTI) ± (10 ml + 10%VTI)*Rate Total Breath Rate (Rtot) ± 1 bpm I:E Ratio (I:E) ± 50 ms or 10%, whichever is greater I/T Ratio (I/T) ± 50 ms or 10%, whichever is greater Inspiratory Time (I Time) ± 100 ms Inspiratory Minute Volume (M VoI) +/- (10ml + 10%) Clinician’s Manual B-3 Specifications Table B-9. Monitored Parameter Tolerances (Continued) Ventilator Parameters Tolerances Leak ± (3 lpm + 20%) Apnea Index (AI) ± 1 ev/h Apnea Time ±1s % Spontaneous (Spont) ±1% a. The Puritan Bennett™ 520 Ventilator does not have the capability to reduce pressure below the PEEP pressure during the exhalation phase. B-4 Clinician’s Manual Range, Resolution, and Accuracy B.6 Range, Resolution, and Accuracy Table B-10 lists the ranges, resolutions, and accuracies for ventilator settings, alarm settings, and patient data. Table B-10. Ventilator Range, Resolution, and Accuracy Ventilator Settings Range, Resolution, and Accuracy Mode Range: P A/C, PSV, CPAP Resolution: N/A Accuracy: N/A Default value: P A/C Vt Target Range: 50 mL to 2000 mL Resolution: 10 mL Accuracy: Vt target < VTI < Vt target +20% if Max P is high enough to reach Vt target Default value: OFF (100 mL) Peak Inspiratory Pressure Range: 5 mbar to 55 mbar in valve configuration (PIP) Range: 5 mbar to 30 mbar in leak configuration Resolution: 1 mbar Accuracy: ± (1 mbar + 10%) of P Control + PEEP setting Default value: 15 mbar Depends on PEEP when Relative Pressure is set to YES Pressure control Range: 5 mbar to 55 mbar in valve configuration (P Control) Range: 6 mbar to 30 mbar in leak configuration Resolution: 1 mbar Accuracy: ± (1 mbar + 10%) of P Control + PEEP setting Default value: 15 mbar Depends on PEEP when Relative Pressure is set to YES Pressure support (P Support) Range: OFF or 5 mbar to 55 mbar in valve configuration Range: 6 mbar to 30 mbar in leak configuration Resolution: 1 mbar Accuracy: ± (1 mbar + 10%) of P Support + PEEP setting Default value: 15 mbar Depends on PEEP when Relative Pressure is set to YES I:E Ratio (I:E) Range: from 1:1 to 1:4 Resolution: 1/0.1 s Accuracy: ± 50 ms or 10%, whichever is greater Default value: 1/2 I/T Ratio (I/T) Range: 20% to 50% Resolution: 1% Accuracy: ± 50 ms or 10%, whichever is greater Default value: 33% Respiratory rate (R-Rate) Range: 5 bpm to 60 bpm in P A/C mode Resolution: 1 bpm Accuracy: ± 1 bpm Default value: 13 Clinician’s Manual B-5 Specifications Table B-10. Ventilator Range, Resolution, and Accuracy (Continued) Ventilator Settings Range, Resolution, and Accuracy Inspiratory sensitivity (I Sens) Range: 1P-5 Resolution: 1 Accuracy: NA Default value: 2 in CPAP, I Sens is set to 2 and is not adjustable Exhalation sensitivity (E Sens) Range: 5% to 95% of peak flow Resolution: 5% Accuracy: ± (4 lpm +10%) of target exhalation flow based on E Sens within 50ms Default value: 25% In CPAP, E Sens is fixed at 25% and is not adjustable. Ramp (Flow Pattern) Range: Descending ramp (D) Resolution: N/A Default value: Descending ramp (D) PEEP Range: OFF (0.5 mbar) to 20 mbar Resolution: 1 mbar Accuracy: ± (1 mbar + 10%) mbar Default value: OFF Depends on: PIP in P A/C and PSV modes when Relative Pressure is set to YES Rise time Range: 1-4 Resolution: 1 Default value: 2 Depends on: Insp time Backup rate Range: 4-40 bpm Resolution: 1 bpm Default value: 13 Depends on: Min I time Apnea time Range: AUTO or 1-60 s Resolution: 1 s Default value: AUTO Depends on: Backup R In PSV, Apnea time: AUTO = 60/Backup R In CPAP, Apnea Time: AUTO = 30 Minimum Inspired Tidal Volume (Min VTI) Range: 30 mL to 1990mL Resolution: 10 mL Default value: 300 Depends on: Max VTI Maximum Inspired Tidal Volume (Max VTI) Range: 80 mL to 3000 mL Resolution: 10 mL Default value: 2000 mL Depends on: Min VTI B-6 Clinician’s Manual Environmental Table B-10. Ventilator Range, Resolution, and Accuracy (Continued) Ventilator Settings Range, Resolution, and Accuracy Maximum Respiratory Rate (Max Rtot) Range: 10 bpm to 70 bpm Resolution: 1 bpm Default value: OFF Depends on: R-Rate Minimum Inspiratory Time (Min I time) Range: 0.1 to 2.8s Resolution: 0.1 s Default value: AUTO (Rise time + 300 ms) Depends on: Max I Time, Backup R, Rise time Maximum Inspiratory Time (Max I time) Range: 0.8 to 3 s Resolution: 0.1 s Default value: AUTO {Min [3 s; (30/R-Rate)]} Depends on: Min I Time, R-Rate B.7 Environmental The following environmental conditions shall be observed: Table B-11. Environmental Conditions for Storage or Transport Temperature Humidity Atmospheric pressure Altitude -40° C to +70° C 10% to 95% RH 500 hPa to 1060 hPa -152 m to 3964 m (7.2 psi to 15.4 psi) (-500ft to 13,000 ft) (-40°F to +158 °F) Table B-12. Environmental Conditions for Operation Temperature Humidity Atmospheric pressure Altitude +5°C to 40°C 10% to 95% RH 600 hPa to 1100 hPa -152 m to 3964 m (8.7 psi to 16.0 psi) (-500 ft to 13,000 ft) (+41 °F to104 °F) Under extreme conditions of use that are beyond the recommendations above but within the limits of a supply voltage of –20%, compared to the nominal temperature or the combination of a temperature of 45 °C (113 °F) and humidity of 75% RH, the ventilator should not malfunction nor endanger the user. However, operating the device for prolonged periods or repeatedly under such extreme conditions could result in premature aging of components and more frequent maintenance. B.8 USB Table B-13. USB Memory Device Specifications Characteristics Supported formats USB compatibility USB flash memory USB 2.0 or USB 1.1 Memory file format USB 32 bit format (sector size: 512 - 2,048 bytes) Number of files Maximum 999 USB size 128 MB to 4 GB Clinician’s Manual B-7 Specifications Table B-14. Data Transfer Characteristics B.9 Ventilator data description Capacity Trends capacity 86 MB Events capacity 512 KB or 5,500 events Monitorings capacity 42 MB / 48 hours Pneumatic Table B-15. Airway Resistances Inspiratory Exhalation 1.0 mbar at 30 lpm flow ± 0.1 mbar 0.5 mbar at 30 lpm ± 0.1 mbar 3.7 mbar at 60 lpm flow ± 0.1 mbar 1.1 mbar at 60 lpm ± 0.1 mbar Table B-16. Air Inlet Resistance (Filter) 1.1 cmH20 (1.079 mbar) at 30 lpm flow +/- 0.1 cmH2O Table B-17. Oxygen Inlet Specifications Maximum pressure Maximum flow See Table B-8, “Performance Parameter Specifications and Tolerances” 50 kPa (7 psi) 15 lpm Table B-18. Performance Specifications B-8 Working pressure Sound pressure level Maximum pressure limit Internal compliance (ventilator) Inspiratory triggering response time (Ttr) 5 mbar – 55 mbar 30 dBA (per NF EN ISO 17510-1 test conditions) 60 mbar .0001 l/mbar 100 ms Clinician’s Manual Manufacturer’s Declaration B.10 Manufacturer’s Declaration The following tables, Table B-19 through Table B-22, contain the manufacturer’s declarations for the ventilator’s electromagnetic emissions, electromagnetic immunity, and recommended separation distances between the ventilator and portable and mobile RF communications equipment, as well as a list of compliant cables. WARNING The Puritan Bennett™ 520 ventilator requires special precautions for electromagnetic compatibility and should be installed and started according to the recommendations found in Appendix B, “Specifications.” In particular, the use of nearby mobile and portable communications equipment using radio frequencies, such as mobile telephones or other systems exceeding the levels set in the IEC 60601-1-2 standard, may affect its operation. Refer to section B.10, “Manufacturer’s Declaration”. The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation. Table B-19. Electromagnetic Emissions The Puritan Bennett™ 520 Ventilator is intended for use in the electromagnetic environment specified below. The customer or the user of the ventilator should assure that it is used in such an environment. RF emissions Group 1 The ventilator uses RF energy only for its internal functions. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment. Class B The ventilator is suitable for use in all establishments including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes. CISPR 11 / EN 55011 RF emissions CISPR 11 / EN 55011 Harmonic emissions Class A IEC / EN 61000-3-2 Voltage fluctuations/ flicker emissions Complies IEC / EN 61000-3-3 Clinician’s Manual B-9 Specifications Table B-20. Electromagnetic Immunity The ventilator is intended for use in the electromagnetic environment specified below. The customer or the user of the ventilator should ensure that it is used in such an environment. Immunity Test IEC / EN 60601 Test Level Compliance Level Electrostatic discharge (ESD) ± 6 kV contact ± 6 kV contact IEC / EN 61000-4-2 ± 8 kV air ± 8 kV air Electrical fast transient/burst ± 2 kV for power supply lines ± 2 kV for power supply lines IEC / EN 61000-4-4 ± 1 kV for input/output lines ± 1 kV for input/output lines Surge ± 1 kV lines/lines ± 1 kV lines/lines ± 2 kV lines/earth ± 2 kV lines/earth IEC / EN 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines @ 5% UT @ 5% UT (# 95% dip in UT for 0.5 cycle) (# 95% dip in UT for 0.5 cycle) IEC / EN 61000-4-11 40% UT 40% UT (60% dip in UT for 5 cycles) (60% dip in UT for 5 cycles) 70% UT 70% UT (30% dip in UT for 25 cycles) (30% dip in UT for 25 cycles) @ 5% UT @ 5% UT (# 95% dip in UT for 5 s) (# 95% dip in UT for 5 s) 3 A/m 3 A/m Power frequency (50/60 Hz) magnetic field IEC/ EN 61000-4-8 Electromagnetic Environment–Guidance Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%. AC power (“mains”) quality should be that of a typical commercial or hospital environment. AC power (“mains”) power quality should be that of a typical commercial or hospital environment. AC power (“mains”) power quality should be that of a typical commercial or hospital environment. If the user of the ventilator requires continued operation during power mains interruptions, it is recommended that the ventilator be powered from an uninterruptible power supply or a battery. Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment. Note: UT is the AC mains voltage prior to application of the test level. B-10 Clinician’s Manual Manufacturer’s Declaration Table B-21. Electromagnetic Immunity – Conducted and Radiated RF The ventilator is intended for use in the electromagnetic environment specified below. The customer or the user of the ventilator should assure that it is used in such an environment. IEC / EN 60601-1-2 Test Level Immunity Test Compliance Level Electromagnetic Environment– Guidance Portable and mobile RF communications equipment should be used no closer to any part of the ventilator, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distance Conducted RF 3 Vrms 3 Vrms IEC / EN 61000-4-6 150 kHz to 80 MHz outside ISM bandsa 150 kHz to 80 MHz outside ISM bands d =0.35√P 10 Vrms inside ISM bandsa 10 Vrms inside ISM bands d=1.2√P 10 V/m 80 MHz to 2.5 GHz 10 V/m 80 MHz to 2.5 GHz Radiated RF IEC / EN 61000-4-3 d=1.2√P80 MHz to 800 MHz d =2.3√P 800 MHz to 2.5 GHz where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres (m)b. Field strengths from fixed RF transmitters, as determined by an electromagnetic site surveyc, should be less than the compliance level in each frequency ranged. Interference may occur in the vicinity of equipment marked with the following symbol: Clinician’s Manual B-11 Specifications Table B-21. Electromagnetic Immunity – Conducted and Radiated RF (Continued) Note: • • At 80 MHz and 800 MHz, the higher frequency range applies. These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. a 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. 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 recommended separation distance for transmitters in these frequency ranges. c 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 RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the ventilator is used exceeds the applicable RF compliance level above, the Puritan Bennett™ 520 Ventilator should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the Puritan Bennett™ 520 Ventilator. d Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 10 V/m. b Table B-22. Recommended Separation Distances The ventilator is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the ventilator can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ventilator as recommended below, according to the maximum output power of the communications equipment. Separation Distance According to Frequency of Transmitter Rated Maximum Output Power of Transmitter (W) 150 kHz to 80 MHz (outside ISM bands) 150 kHz to 80 MHz (in ISM bands) 80 MHz to 800 MHz 800 MHz to 2.5 GHz d=0.35 √P d= 1.2 √P d = 1.2 √P d = 2.3 √P 0.01 0.035 m 0.12 m 0.12 m 0.23 m 0.1 0.11 m 0.38 m 0.38 m 0.73 m 1 .35 m 1.2 m 1.2 m 2.3 m 10 1.1 m 3.8 m 3.8 m 7.3 m 100 3.5 m 12 m 12 m 23 m For transmitters rated at a maximum output power not listed above, the recommended separation distance d in metres (m) can be determined using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. Note: • • At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. 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. • 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. • These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. B-12 Clinician’s Manual Standards Compliance and IEC Classification Table B-23. Compliant Cables and Accessories Cable or Accessory Maximum length UK AC power cable assembly 1.8 m (5.9 ft) Japan AC power cable assembly 1.8 m (5.9 ft) China AC power cable assembly 1.8 m (5.9 ft) South Africa AC power cable assembly 1.8 m (5.9 ft) India AC power cable assembly 1.8 m (5.9 ft) Australia AC power cable assembly 1.8 m (5.9 ft) Europe AC power cable assembly 1.8 m (5.9 ft) Canada AC power cable assembly 1.8 m (5.9 ft) Nurse call cable 5 m (16.4 ft) 12V DC car adapter cable 5 m (16.4 ft) Oxygen inlet connector - B.11 Standards Compliance and IEC Classification General Standards • Medical Electrical Equipment: General Requirements for Safety IEC 60601-1:1990 and EN 60601-1:1990 and all its amendments up to 1995. • The ventilator will be constructed to comply with the following product Classifications as detailed in Clause 5 of 60601-1: • • • • • • • • Class II Equipment Internally Powered Equipment Type BF Applied Parts IP31 with respect with respect to access to hazardous parts and ingress of moisture Not suitable for use in the presence of flammable anesthetic mixtures Not suitable for sterilisation Suitable for continuous operation Detachable power supply cable • Supplement No. 1-94 to CAN/CSA-C22.2 No. 601.1-M90 - Medical Electrical Equipment - Part 1: General Requirements for Safety. • UL 60601-1 Medical Electrical Equipment - Part 1: General Requirements for Safety: 2003. Collateral Standards • Medical Electrical Equipment - Part 1: General Requirements for Safety -2- Collateral standard Electro-Magnetic Compatibility requirements and tests IEC 60601-1-2:2007 and EN 60601-1-2: 2007. • Medical Electrical Equipment - Part 1: General Requirements for Safety -2- Collateral standard: Programmable Electrical Medical Systems IEC 60601-1-4:2000 and EN 60601-1-4:2004. • Medical Electrical Equipment - Part 1: General Requirements for Safety -2- Collateral standard: Usability IEC 60601-1-6:2006 and EN 60601-1-6:2007. • General Requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems IEC 60601-1-8:2003 and EN 60601-1-8:2007. Clinician’s Manual B-13 Specifications Particular Standards • Lung Ventilator for Medical Use-Particular Requirements for Basic Safety and Essential Performance Part 6: Home-care ventilatory support devices EN ISO 10651-6: 2009. • Lung Ventilators for Medical Use- Particular Requirements for Basic Safety and Essential Performance Part 1: Home Care Ventilator Support YY 0600.1-2007 (ISO 10651-6:2004, MOD). • Anesthetic and respiratory equipment - Conical connectors - Part 1: Cones and sockets EN ISO 5306-1:2004. Air Transportation Standards • Environmental Conditions and Test Procedures for Airborne Equipment - RTCA/DO-160:2007. B-14 Clinician’s Manual Architecture C Theory of Operation C.1 Architecture The Puritan Bennett™ 520 Ventilator’s gas delivery system is primarily composed of an airflow generator and a three-way valve to control the patient circuit exhalation valve. The flow generator is a low-inertia, micro-turbine driven by a brushless DC electric motor, while the three-way valve is a proportional solenoid valve. These two actuators are microprocessor-controlled and perform according to specific control algorithms. The microprocessor control circuit receives its data from the various servo-controlled pressure and feedback flow sensors that are built into the ventilator. An electrical supply management system performs the energy conversions necessary for operation and switching between the available power sources and the regulated load of the internal battery. A cooling fan helps maintain the proper operating temperature range for the internal environment of the ventilator. This fan is servo-controlled to maintain the proper temperature for the most heatsensitive of the ventilator’s components. C.2 Operation The operation of the device is based on a self-adapting, closed loop drive system. The speed of the flow generator (turbine) is servo-controlled according to the patient pressure signal or the inspired flow signal. The turbine speed control algorithms themselves are based on equations that vary according to the ventilation modes, settings, and the respiratory cycle phases. Thus, fixing the pressure rise time or flow pattern has an influence on the level of turbine acceleration at the start of the inspiration phase. The transition between the inspiration phase and expiration phase is controlled by a deceleration or braking algorithm proportional to the pressure difference between the two phases. The exhalation solenoid valve (three-way valve) is fully closed during the inspiratory phase and is proportionally controlled during the exhalation phase to obtain the bias flow. The speed of the turbine adapts to the exhalation pressure threshold during the entire exhalation phase to maintain the operator-set PEEP. The flow measurement completes the system by enabling detection of patient inspiratory effort and the triggering of inspiration phases. The flow measurement can also be used to determine the end of the inspiration phase in certain ventilation modes. The flow measurement is automatically corrected as a function of the atmospheric pressure measured inside the ventilator with the Altitude Compensation feature1. The flow and volume are in Body Temperature Pressure Saturated (BTPS) conditions. This necessitates that periodic inspections for calibrating the sensors be performed by maintenance technicians authorised by Covidien (refer to the Puritan Bennett™ 520 Ventilator Service Manual). If the Altitude Compensation feature is active, a corrective algorithm is applied to the inspiration flow. The sensor measurement range is software limited from 600 to 1100 hpa. 1. The Altitude Compensation feature is enabled (set to “YES” on the Setup Screen) by default and should remain at this setting. Clinician’s Manual C-1 Theory of Operation A cooling fan is provided to maintain the internal temperature of the ventilator within specified limits and to help ensure proper performance and longevity of the device. Finally, the various measurement signals used in control and detection are protected and specifically filtered in order to limit any risk of disturbance to the device and possible problem. 1 Air inlet filter 7 Exhalation valve exhaust port 2 Turbine 8 Exhalation tubing 3 Inspiratory filter 9 LCD display 4 Inspiratory tubing 10 CPU board 5 Proximal pressure tube 11 Internal battery 6 Exhalation valve Figure C-1. Gas Delivery System C-2 Clinician’s Manual Modes of Ventilation D Modes and Breath Types D.1 Modes of Ventilation This chapter is a general description of the various modes of ventilation and breath types available with the Puritan Bennett™ 520 Ventilator. Note: The default ventilation mode setting is P A/C; for more information, see below. D.1.1 Assist/Control (A/C) Mode When set to an Assist/Control mode, machine-initiated breaths are delivered at a clinician-set pressure and rate. If the patient triggers a spontaneous breath between machine breaths, the ventilator will deliver a breath based on the pressure settings. Whether initiated by the patient or the ventilator, all breaths are delivered at the same preset pressure. The name of the Assist/Control mode is P A/C, if the breaths are based on a pressure setting. D.1.2 CPAP Mode In CPAP, the ventilator maintains a constant level of pressure in the patient’s airway. D.1.3 PSV Mode PSV mode maintains a constant level of pressure in the patient’s airway during exhalation. In addition, the ventilator applies a clinician-set pressure (Pressure Support) to each of the patient’s breaths. This has the same benefits as CPAP, with the additional benefit of assisting the patient in moving gas into his or her lungs. D.2 Breath Types Breath types available from the ventilator are: • Pressure controlled breaths in Assist/Control mode (in P A/C) • Pressure-supported breaths in PSV mode • CPAP D.2.1 Pressure Control Breaths in Assist/Control Mode In Assist/Control mode (P A/C), each delivered breath will maintain the selected pressure (P Control) maintained over the selected inspiratory time (calculated with R Rate and I:E (I/T) ratio). Inspiration is triggered by patient-generated flow (for assisted breaths) or by the ventilator (for controlled breaths; breath rate [R-Rate] is the controlling parameter). For both controlled and assisted breaths, the inspiratory pressure is limited to the pressure (P Control) setting, and is cycled by time. Clinician’s Manual D-1 Modes and Breath Types The shape of the pressure waveform depends on the setting of the pressure rise time (Rise Time). Start of Inspiration Start of Inspiration End of Inspiration End of Inspiration Airway Pressure Airway Pressure Flow Flow Time Time Figure D-1. Flow Patterns in P A/C Mode P A/C mode guarantees a maximum period between breaths, as determined by the Breath Rate setting. In Figure D-1, the ventilator delivers a controlled (machine) breath, and calculates the time before another controlled breath must be delivered. The ventilator delivers a second controlled breath at the conclusion of the machine calculated breath time (for simplicity, we will use the term period for “machine-calculated breath time“). Following the second controlled breath, but before another period can elapse, the patient's effort triggers an assisted (or patient-initiated) breath. This restarts the period. At the conclusion of the period, the ventilator delivers another controlled breath. Period Period Period Airway Pressure Machine breath Machine breath Patient Initiated Breath Machine breath Time Figure D-2. Controlled Machine Breaths in P A/C Mode D.2.2 Pressure Supported Breaths in PSV Mode In PSV mode, the supported breaths maintain the selected pressure (P Support). Inspiration is triggered by patient-generated flow. The inspiration is terminated when inspiratory flow drops to the Exhalation Sensitivity (E Sens) setting. The shape of the pressure waveform depends on the setting of the pressure rise time (Rise Time). Refer to Figure D-3. D-2 Clinician’s Manual Ventilation Modes and Apnea Flow Flow 25% 50% Time Figure D-3. Pressure Supported Breaths in PSV Mode D.2.3 CPAP In Continuous Positive Airway Pressure (CPAP) the ventilator maintains pressure at the selected PEEP over the entire breath cycle. Inspiration is triggered by patient-generated flow. Inspiration is limited by the pressure and is cycled by the patient when inspiratory flow drops to the Exhalation Sensitivity threshold (E Sens = 25%). Refer to Figure D-4. Airway Pressure Start of Inspiration End of Inspiration Flow Figure D-4. Flow Patterns in CPAP Mode D.3 Ventilation Modes and Apnea In PSV mode, the back-up rate is activated so that the ventilator will automatically begin to deliver breaths at the breath rate (Backup R) setting if no patient effort occurs for the Apnea Time setting. The pressure during a back-up breath is equal to the Pressure Support (P Support) setting before the apnea condition began. If the patient initiates a spontaneous breath while the back-up rate is in effect, the ventilator will return to the previous operating parameters. In CPAP, a backup rate is not set, but the operator must still set an apnea time (Apnea Time). In that case, the ventilator will sound an APNEA alarm if no breath is triggered by the patient in the apnea time; however, no back up breaths will be generated. Clinician’s Manual D-3 Modes and Breath Types D.4 VT Target The Puritan Bennett™ 520 Ventilator has the Vt Target (Target Volume) feature as a part of pressurebased ventilation modes. This allows a range of pressures to be used to reach a set volume. If the mode is PSV ST or P A/C, Vt Target can be selected within the range of 50 to 2000 mL (or OFF) which controls the inspired tidal volume to the target value specified. Following each delivered breath, the inspired volume is measured and small pressure adjustments (0.5-2 mbar) are made as necessary to maintain the delivered volume within the target Vt range. If the inspired volume is lower than the target volume, the pressure of the next breath increases a small amount and the inspired volume is measured again. If the inspired volume is higher than the target volume, the pressure of the next breath is decreased slightly, until the inspired volume matches the target volume. The pressure increases stop if the maximum inspiratory pressure is reached. Figure D-5. Target Volume in Pressure Modes Table D-1. Volume target measurements in pressure modes Cycle number D-4 1 2 3 4 5 6 7 8 9 10 PIP set point (cmH2O, mbar or hPa) 20 20 + 0.5 = 20.5 20.5 +1= 21.5 21.5 +2= 23.5 23.5 23.5 23.5 0.5 = 23 23 23 + 0.5 = 23.5 23.5 Measured Vti (ml) 380 400 450 530 550 610 580 490 510 520 = = = = Clinician’s Manual E Operational Verification Checklist The operational verification and safety checks listed in Table E-1 below should be performed to ensure the ventilator is operating properly in the following circumstances: • Prior to using the ventilator with a patient. • Regularly, according to institutional protocol. • Following maintenance or changes in ventilator settings. If the ventilator fails any of the safety checks below, or if you cannot complete these checks, refer to section 5.8, “Troubleshooting,” on page 5-14 or call the equipment supplier or Covidien (refer to section 10.3, “Service Assistance,” on page 10-3). WARNING Provide the patient with an alternate means of ventilation before conducting these tests. To reduce the risk of infection, wash your hands thoroughly before and after handling the ventilator or its accessories. Table E-1. Operational Verification Checklist 1 Verify the proper appearance and cleanliness of the ventilator. 2 Verify all of the labels and markings on the ventilator are clear and legible. 3 Confirm the air inlet filter is clean and correctly installed. 4 Ensure the AC power cable does not exhibit any signs of damage, such as kinks, breaks, or damaged insulation. 5 Connect the AC power cable. Ensure that all power supply indicators on the front panel flash, except for the AC power supply (mains) indicator, which should remain lit. 6 Push the power switch I/O to the I position to activate the ventilator test: Check that the two alarm indicators and the Standby indicator (located key) flash. Ensure also that the close to the VENTILATOR ON/OFF two alarm buzzers sound. 7 Perform the Functioning Alarms Test regularly according to institutional protocol (refer to Appendix F, “Alarms Tests”). Pass 8 Verify the alarm volume is adapted to the patient environment. Refer to section 7.3, “Preferences Menu Parameters,” on page 7-9 for instructions on changing the alarm volume setting. Pass 9 Verify that the preventive maintenance schedule for the ventilator is followed. Refer to chapter 10, “Routine Maintenance”. Pass Ensure the patient breathing circuit is correctly attached to the ventilator, with all the necessary components, and is free from any signs of damage and leaks. Pass 10 Clinician’s Manual Pass Pass Pass Pass Pass Pass E-1 Operational Verification Checklist This page intentionally blank E-2 Clinician’s Manual Low Pressure Test F Alarms Tests Before connecting the ventilator to the patient, perform the following tests to ensure the ventilator‘s alarms are working properly. F.1 Low Pressure Test WARNING Do not perform ventilator alarm tests while the patient is connected to the ventilator. Provide the patient with an alternate means of ventilation before conducting these tests. If the ventilator fails any alarm test or if you cannot complete these tests, see the Troubleshooting section (refer to chapter 5, “Alarms and Troubleshooting”) of this manual or call your equipment supplier or Covidien (refer to section 10.3, “Service Assistance,” on page 10-3). The setting of the Min PIP alarm must be adjusted for the patient, but must also be set high enough to allow the PATIENT DISCONNECTION alarm to trigger properly. Perform the Low Pressure Test (refer to section F.1, “Low Pressure Test,” on page F-1) to ensure the Min PIP alarm is properly set. Note: Most of these tests require that an approved patient circuit be connected to the ventilator. Ensure that your patient circuit is properly connected prior to performing these tests. WARNING The setting of the Min PIP alarm must be adjusted for the patient, but must also be set high enough to allow the PATIENT DISCONNECTION alarm to trigger properly. Perform the following test to ensure the Min PIP alarm is properly set. 1. Before proceeding, set the ventilation and alarm parameters specified by the patient’s clinician and install a single limb circuit setup. 2. Press the VENTILATION ON/OFF key to start ventilation. 3. Keep the patient‘s end of the breathing circuit open and allow ventilation to continue. 4. Wait for (Apnea Time + 2 seconds; Apnea time is not always 5 seconds), then ensure that: • the High priority indicator (red colour) lights up • the “PATIENT DISCONNECTION” alarm is displayed • the audible alarm sounds 5. Press the ALARM CONTROLkey once to silence the alarm. 6. Press and hold the VENTILATION ON/OFF key for three (3) seconds, then release it. Press the VENTILATION ON/OFF key again to confirm stop. The ventilator will switch to Standby mode and cancel the alarms. Clinician’s Manual F-1 Alarms Tests F.2 Apnea Test Apnea breaths only apply in PSV and CPAP modes. 1. Connect the patient end of the patient circuit to a test lung. 2. Verify that the pressure tube of the patient circuit is properly connected to the appropriate fitting on both the ventilator and the proximal pressure port (refer to section 6.4, “Patient Circuit,” on page 6-6). 3. Press the VENTILATION ON/OFF key to start ventilation. The ventilator will deliver a mandatory breath. Before the second mandatory breath is delivered, verify that the following events occur: • the Medium priority indicator (yellow colour) illuminates • the “APNEA“ alarm is displayed • an audible alarm sounds 4. Press the ALARM CONTROL key twice to reset the alarm. 5. Press and hold the VENTILATION ON/OFF key for three (3) seconds, then release it. Press the VENTILATION ON/OFF key again to confirm stop. • Ventilation stops. F.3 Power Failure Test Note: If the ventilator is operating on either the external power supply or the internal battery, you must plug it in to an AC power source before beginning this test. 1. Disconnect the ventilator from its AC power supply. Ensure that the following events occur: • • • • the Medium priority indicator (yellow colour) illuminates the “AC POWER DISCONNECTION“ alarm activates an audible alarm sounds the DC POWER indicator illuminates if the DC power source is connected; otherwise, the INTERNAL BATTERY indicator illuminates 2. Press the ALARM CONTROL key twice to reset the alarm. 3. Reconnect the ventilator to its AC power supply. F.4 Occlusion Test Note: Occlusion testing can only be done in Pressure modes. 1. Verify that the pressure tube of the patient circuit is properly connected to the appropriate fitting on both the ventilator and the proximal pressure port (refer to section 6.4, “Patient Circuit,” on page 6-6). 2. Block the exhalation port on the exhalation valve of the patient circuit. Refer to Figure F-1 on page F-3. F-2 Clinician’s Manual Testing the Battery Figure F-1. Blocking the Patient End of a Single Limb Circuit 3. Press the VENTILATION ON/OFF key to start ventilation. 4. Allow the ventilator to deliver three (3) consecutive breaths. At the beginning of the fourth breath, ensure that the following events occur: • the High priority indicator (red colour) illuminates • the “Occlusion“ alarm activates • an audible alarm sounds 5. Press the ALARM CONTROL key to silence the alarm. 6. Unblock the exhalation port. • the occlusion alarm is cancelled. 7. Press and hold the VENTILATION ON/OFF key for three (3) seconds, then release it. Press the VENTILATION ON/OFF key again to confirm stop. • Ventilation stops. F.5 Testing the Battery The ventilator is capable of testing the power of the battery (refer to chapter 8, “Internal Battery”). You can determine which power source the ventilator is using by checking the power indicator, located on the top panel. The indicator light will be lit to indicate which power source is currently available. 1. Disconnect the AC power supply cable and the DC power cable (if it is connected) from the ventilator. • a POWER DISCONNECTION alarm will trigger. 2. Press the ALARM CONTROL key twice to pause the alarm. Ensure that the following events occur: • the INTERNAL BATTERY indicator to the upper-left of the display illuminates • the BATTERY symbol is displayed at the top of the screen (along with its reserve capacity) 3. Connect the AC (mains) power supply. Ensure that the following events occur: • the AC POWER indicator to the upper-left of the display illuminates • the indicator to the upper-left of the display is flashing, which indicates that the battery is charging (this only occurs if the ventilator has run on battery power long enough to lose enough charge that the charger will turn on) • the BATTERY to the upper-left of the display symbol is no longer displayed at the top of the screen Clinician’s Manual F-3 Alarms Tests F.6 Involuntary Stop Test To verify proper functioning of the Very High Priority audible alarm, perform the following: 1. Press the VENTILATION ON/OFF key to start ventilation. 2. Set the I/O switch to the O (off ) position to power-down the ventilator during ventilation. Ensure that the following events occur: • An audible alarm sounds continuously • The ventilator turns off. There should be no alarm indicators illuminated and no alarm messages displayed. 3. Press the ALARM CONTROL key once to silence the audible alarm. F-4 Clinician’s Manual G Unpacking and Preparation The Puritan Bennett™ 520 Ventilator is delivered with the following items: (1) Printed User's Manual (language as requested by the customer) (1) Clinician's Manual on CD (a print copy is available upon request by the customer) (1) Patient circuit and valve (1) Set of six (6) combination foam/fine particle air inlet filters (1) Carrying bag (1) Oxygen connector (1) AC power cable WARNING Users must always possess an additional circuit and valve while using the Puritan Bennett™ 520 Ventilator. To minimise the risk of damage, you must use the Dual Bag to transport the Puritan Bennett™ 520 Ventilator. Refer to Figure G-2. To unpack and prepare the ventilator, follow the steps below. 1. From the plastic bag, remove the following: • Plastic pocket containing the Clinician’s Manual. • The ventilator and its components and/or accessories. 2. Remove the patient circuit, the AC (“Mains”) power cable, and the set of fine-particle air inlet filters 3. Inspect the ventilator and ensure that: • the ventilator’s outer casing and the I/O switch’s protective cover do not have any dents or scratches, which may indicate possible damage. • the ventilator’s labels and markings are clear and legible. • the AC power cable does not exhibit any signs of damage, such as kinks, breaks, or cuts. WARNING Never use a ventilator or any components or accessories that appear to be damaged. If any signs of damage are evident, contact your equipment supplier or Covidien. 4. Clean the ventilator with a mild soap solution, if necessary (refer to chapter 9, “Cleaning”). 5. Ensure that the air inlet filter is installed. Clinician’s Manual G-1 Unpacking and Preparation Figure G-1. Puritan Bennett™ 520 Ventilator Figure G-2. Dual Bag G-2 Clinician’s Manual H Parts and Accessories Table H-1 provides a list of accessories that are available for the Puritan Bennett™ 520 Ventilator. To order parts or accessories, contact your equipment supplier or Covidien representative. Note: The ventilator is delivered with the following items: a printed User’s Manual, a CD with Clinician’s Manual (printed copy available upon request); one patient circuit with valve; one set of six (6) combination foam/fine particle air inlet filters; one carrying bag; one O2 connector; and one AC power cable. Table H-1. List of Consumables and Accessories Description Carrying bag (grey) Oxygen inlet connector Ventilator Cart Dual Bag (blue or pink) delivered with: Backpack Padded Straps, 2 ea. Suspension belt Carrying belt WARNING To minimise the risk of damage, you must use the ventilator’s Dual Bag to transport the ventilator. See Figure G-2 on page G-2. AC (mains) power cable DC power cable (for connection to an external DC power source, such as a car 12 volt DC outlet) Nurse call cable (5 metres) Inlet air combi-filter, fine (pack of 6) Note: This is the “foam plus fine particle” filter listed in Table 10-1, Consumables and Replacement Intervals, on page 10-2). Internal battery External battery 3-way DAR™ valve DAR™ Inspiratory Bacteria Filters Barrierbac Barrierbac S Barrierbac S Angled Hygrobac Hygrobac S Hygrobac S Angled Clinician’s Manual H-1 Parts and Accessories Table H-1. List of Consumables and Accessories Description Hygroboy Hygroster Hygroster Mini Sterivent Sterivent S Sterivent Mini Hygrolife II Table H-2 provides a list of consumable parts available for the ventilator. WARNING To ensure proper performance of the ventilator, use a patient circuit recommended by Covidien in this manual; refer to chapter 6, “Installation and Assembly” and Appendix H, “Parts and Accessories”. The total specified length of the patient circuit tubing as measured from the ventilator outlet to the ventilator inlet is 1.1 metres (3.6 ft) to 2.0 metres (6.6 feet). The tubing must conform to all applicable standards and must be fitted with Ø 22 mm terminals that also conform to all applicable standards. Ensure that both the length and the internal volume of the patient circuit are appropriate for the tidal volume: a corrugated tube of Ø 22 mm for adult patients, and a corrugated tube of Ø 15 mm for pediatric patients with a tidal volume lower than 200 ml. Table H-2. List of Circuits Description Part Number DAR™ Single limb patient circuit with exhalation valve, 180 cm, PVC, ADULT 5093600 DAR™ Single limb patient circuit with exhalation valve, 180 cm, PVC, PEDIATRIC 5093500 DAR™ Single limb patient circuit without exhalation valve, 180 cm, PVC, ADULT 5093300 DAR™ Single limb patient circuit without exhalation valve, 180 cm, PVC, PEDIATRIC 5093100 For more information regarding parts and accessories for the Puritan Bennett™ 520 Ventilator contact your service representative or http://www.respiratorysolutions.covidien.com. H-2 Clinician’s Manual I Glossary AC Power Alternating current. Alarm Pause The audible and visual alarms cease and the symbol appears. The symbol will remain until the cause of the alarm is addressed. For example, when the ventilator is running on internal battery, the AC Disconnection alarm may be paused, and the alarm paused symbol will appear until the device is plugged into AC. The paused alarm will be captured in the alarm log screen and can be reactivated. Alarm Reset Used only for the High Pressure alarm, this function resets the visual alarm message. Apnea The absence of breathing or a breathing pattern capable of supporting an individual's respiratory needs. Apnea Index (AI) The Apnea index is average number of apnea events per hour of ventilation. It is based on the Apnea Alarm. Apnea Time Time allowed between breath starts before APNEA alarm occurs when no patient effort is detected. Assist/Control In Assist/Control mode, the ventilator delivers an assisted breath of a set pressure when the patient's breathing effort creates a flow or pressure drop that is greater than the SENSITIVITY setting. In absence of patient breathing effort, the ventilator will deliver a controlled breath of the set pressure. (Does not apply in PSV/CPAP mode). Assisted Breath A pressure breath triggered by the patient but then controlled and terminated by the ventilator. Audio Pause Pauses the audible alarm for 60 seconds at a time and shows the “Alarm Silence.” symbol; often referred to as Back Up Rate Rate of control cycles in PSV mode during apnea phase. Battery Level Display of the remaining battery capacity; located adjacent to the battery symbol. Clinician’s Manual I-1 Glossary Bias flow Turbine flow during exhalation phase through the patient circuit to avoid rebreathing. bpm An abbreviation for “breaths per minute,” which is the unit of measure for breath rate (see below). Breath Rate (Back Up R) The total number of breaths, both machine and spontaneous, delivered by a ventilator in one minute. Caregiver An individual who assists a patient with the tasks of daily living. This may be a family member, a live-in assistant, or the nursing staff of a health care facility. cmH2O An abbreviation for “centimetres of water,” which is a unit of measure for pressure. Continuous Positive Airway Pressure (CPAP) Continuous airway pressure maintained throughout a spontaneous breath cycle. Controlled breath A pressure breath triggered, controlled and terminated by the ventilator. DC Power Direct current. Exhalation Phase Phase of the breath cycle during which the patient exhales. Exhalation Sensitivity The exhalation sensitivity (E Sens) level is a percentage of peak flow at which a pressure-supported breath will be terminated. Fraction of Inspired Oxygen (FiO2) Amount of oxygen delivered to the patient. Flow Volume of gas delivered by the ventilator compared to time, expressed in litres per minute (lpm). hPa An abbreviation for “hectopascal“ which is a unit of measure for atmospheric pressure. I:E ratio Inspiratory time versus exhalation time ratio. Inspiratory Phase Phase of the breath cycle during which the patient inspires. I-2 Clinician’s Manual Inspiratory Sensitivity (I Sens) Level of inspiratory effort the patient has to provide during the initiation of a machine breath. The sensitivity levels (from 1P to 5) correspond to differences in flow compared to the bias flow. Level 1P is the most sensitive (for a pediatric use) and requires the least effort to trigger a breath. Level 5 requires the most amount of effort to trigger a breath. Inspiratory Tidal Volume (VTI) Volume delivered to the patient at each inspiratory phase. I Time (Inspiratory Time) Inspiratory time measure. Intentional Vent Stop Alarm Intentional Ventilation Stop Alarm - Ventilation has been switched off by the user / caregiver and the ventilator is in stand-by. I/T Ratio Inspiratory time versus total breath time ratio. L litres (a unit of volume). Leak When ventilating in leak configuration, it is the averagepatient/circuit leak during each cycle and over the past 24 hour period. LED Light Emitting Diode; used as indicator lights on the ventilator’s front panel. lpm Litres Per Minute (a unit of volume flow rate). Machine Hours Counter Counter for the total ventilation time since manufacture or the last CPU board change. Mains AC power supply. Max Leak The maximum alarm setting of a high leakage threshold. An alarm will be triggered in the event the calculated leakage is exceeded. Max Rtot (Total breath rate) The maximum alarm setting to prevent hyperventilation or ventilator autotriggering. The HIGH RATE alarm will be triggered if the total breath rate exceeds the maximum limit set. Max P (Maximum Inspiration Pressure) Max P allows the ventilator to adjust the inspiratory pressure up to a maximum limit in order to reach the target tidal volume (Vt Target). Clinician’s Manual I-3 Glossary Mbar An abbreviation for “millibar“ which is a unit of measure for atmospheric pressure. Mean Airway Pressure Average patient pressure during each breath. Minimum Exhalation Time Minimum exhalation time before allowing the patient inspiratory trigger. Minimum Inspiratory Time Minimum inspiratory time before allowing the patient to exhale. M Vol (Minute Volume) Flow delivered at each breath to the patient is measured by the inspiratory flow sensor and that measurement is used to calculate minute volume (Vt x Rtot) P A/C (Pressure Assist /Control) A ventilator mode which provides machine-initiated breaths delivered at a clinician-set pressure, inspiratory time, and rate. Patient Breath Breathing cycle initiated by the patient. Patient circuit Tubing between the ventilator and the patient. Patient effort Inspiratory effort initiated by the patient. Patient Hours Counter Counter of ventilation time for the patient. Peak Airway Pressure (PAW) The Peak Airway Pressure is the average peak pressure during the inspiratory phase, measured by each cycle and over the previous 24 hour period. Peak Inspiratory Pressure (PIP) The highest pressure measured in the patient circuit during the inspiration phase. Positive End Expiratory Pressure (PEEP) Pressure in the patient circuit at the end of expiration. Pressure Control (P Control) Augmentation of the patient's ventilation synchronously with inspiratory effort until a preset pressure is met. Pressure is maintained throughout patient inspiratory flow, and is cycled to expiration by time (controlled by the selected Inspiratory Time setting). Used in Assist/Control mode. I-4 Clinician’s Manual Pressure Support (P Support) Augmentation of the patient’s ventilation synchronously with inspiratory effort until a preset pressure is met. Pressure is maintained until inspiratory flow is reduced to a percentage of peak flow that depends on the exhalation sensitivity setting for the inspiration, when the ventilator cycles into exhalation. Available in Spontaneous mode. PSI Pounds Per Square Inch. PSV (Pressure Support Ventilation) Pressure support ventilation. Rebreathing The patient breathes his/her exhaled gas. Respiration rate The number of breath cycles (inspiration + expiration) completed within one minute. Normal resting adult respiratory rates are from 12 – 20 breaths per minute (bpm). RESTART/SRVC This is an alarm message. If the message “*IF PERSISTS RESTART/SRVC” occurs, restart the ventilator. If the alarm condition is not cleared, call a service representative. Rise Time This determines how the target pressure will be reached, and indirectly defines the minimum inspiration time. Rtot Parameter measured by the ventilator equal to the total number of breaths per minute (bpm). Sensitivity This adjustable parameter determines the amount of inspiratory effort required by the patient before the ventilator delivers an assisted breath, or demands flow in the case of a spontaneous breath. The Puritan Bennett™ 520 Ventilator is pressure-triggered, with sensitivity levels in the range from 1P to 5: the lower the number, the more sensitive the trigger. Spont Cyc (Spontaneous Cycling) This is the percentage of ventilation cycles initiated by the patient over the previous 24 hour period. Spontaneous A ventilation mode that delivers assisted breaths only. Spontaneous mode does not provide breaths if the patient does not make an inspiratory effort greater than the sensitivity settings and there is no apnea backup rate. Standby The operational mode of the ventilator where it is powered (power supply I/O button set to the I position), but is not ventilating the patient. Clinician’s Manual I-5 Glossary Vent Time (Ventilation Time) The ventilation duration data is based on the patient counter and shows the total ventilation time in hours and minutes over the previous 24 hour period. Vt Target (Target volume) The Vt Target feature enables the ventilator to reach a set volume of gas to be delivered to the patient using a range of pressures in the pressure-based ventilation modes. I-6 Clinician’s Manual Index A AC power connecting to. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2 indicator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4 AC power cable disconnecting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4 securing to ventilator . . . . . . . . . . . . . . . . . . . . . . . . . 6-3 AC POWER DISCONNECTION alarm message 5-7, 5-14 Accessories cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2 Air circulation (Warning) . . . . . . . . . . . . . . . . . . . . .1-2, 6-1 Air inlet filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10 replacement interval . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 replacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1 Air inlet filter, replacing (figure) . . . . . . . . . . . . . . . . . 10-2 Air outlet (antibacterial) filter replacement interval . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 Air transport Air transportation standard . . . . . . . . . . . . . . . . . . B-14 use on commercial aircraft . . . . . . . . . . . . . . . . . . . . 2-1 Alarm levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Alarm Logs menu dismissing automatically . . . . . . . . . . . . . . . . . . . . . . 5-4 dismissing manually . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4 Alarm messages AC POWER DISCONNECTION . . . . . . . . . . . . 5-7, 5-14 APNEA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7, 5-14 BATTERY FAULT1 . . . . . . . . . . . . . . . . . . . 5-7, 5-14, 8-4 BATTERY FAULT2 . . . . . . . . . . . . . . . . . . . . . . . 5-7, 5-14 BUZZER FAULT1 . . . . . . . . . . . . . . . . . . . . . . . . 5-7, 5-15 BUZZER FAULT2 . . . . . . . . . . . . . . . . . . . . . . . . 5-7, 5-15 BUZZER FAULT3 . . . . . . . . . . . . . . . . . . . . . . . . 5-7, 5-15 BUZZER FAULT4 . . . . . . . . . . . . . . . . . . . . . . . . 5-8, 5-15 BUZZER LOW BATTERY . . . . . . . . . . . . . . . . . . 5-7, 5-15 CHECK BATTERY CHARGE . . . . . . . . . . . . . . . 5-8, 5-15 CHECK EXH VALVE . . . . . . . . . . . . . . . . . . . . . . 5-8, 5-15 CHECK EXH VALVE PRESSURE. . . . . . . . . . . . 5-8, 5-15 CHECK PROXIMAL LINE1 . . . . . . . . . . . . . . . . 5-8, 5-16 CHECK REMOTE ALARM . . . . . . . . . . . . . . . . . 5-8, 5-16 CHECK SETTINGS. . . . . . . . . . . . . . . . . . . . . . . . 5-8, 5-16 CONNECT VALVE OR CHANGE PRESS . . . . 5-9, 5-16 CONTROLLED CYCLES. . . . . . . . . . . . . . . . . . . 5-9, 5-16 COOLING FAN . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-16 DC POWER DISCONNECTION . . . . . . . . 5-9, 5-16, 6-6 DEVICE FAULT 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9 DEVICE FAULT10 . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-17 DEVICE FAULT11 . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-17 DEVICE FAULT12 . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-17 DEVICE FAULT13 . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-17 Clinician’s Manual DEVICE FAULT3 . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-16 DEVICE FAULT5 . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-16 DEVICE FAULT7 . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-16 DEVICE FAULT9 . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-17 EMPTY BATTERY . . . . . . . . . . . . . . . . . . .5-10, 5-17, 8-3 HIGH INT TEMP COOL VENT . . . . . . . . . . . . 5-10, 5-17 HIGH LEAKAGE . . . . . . . . . . . . . . . . . . . . . . . . 5-10, 5-18 HIGH PRESSURE. . . . . . . . . . . . . . . . . . . . . . . . 5-10, 5-19 HIGH RATE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10, 5-19 HIGH VTI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10, 5-18 HIGH/LOW BATTERY TEMP . . . . . . . . . . . . . 5-10, 5-18 INTENTIONAL VENT STOP . . . . . . . . . . . . . . 5-11, 5-19 KEYPAD FAULT . . . . . . . . . . . . . . . . . . . . . . . . 5-11, 5-19 LOW BATTERY . . . . . . . . . . . . . . . . . . . . .5-11, 5-19, 8-3 LOW VTl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11, 5-19 NO PROXIMAL LINE2 . . . . . . . . . . . . . . . . . . . 5-11, 5-20 OCCLUSION CHECK CIRCUIT. . . . . . . . . . . . 5-11, 5-20 PATIENT DISCONNECTION . . . . . . . . . . . . . 5-12, 5-20 POWER FAULT . . . . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-20 POWER SUPPLY LOSS . . . . . . . . . . . . . . . . . . 5-12, 5-20 PRES SENS FLT1. . . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-20 PROX SENS FLT2 . . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-20 REMOVE VALVE CPAP MODE . . . . . . . . . . . 5-12, 5-21 REMOVE VALVE OR CHANGE PRES . . . . . . 5-13, 5-20 SOFTWARE VERSION ERROR . . . . . . . . . . . . 5-13, 5-21 TURB OVERHEAT . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-21 UNKNOWN BATTERY . . . . . . . . . . . . . . . . . . . 5-13, 5-21 Alarm parameters CPAP Mode Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7 P A/C Mode Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10 PSV Mode Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2 Alarm tests Apnea test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-2 Involuntary stop test . . . . . . . . . . . . . . . . . . . . . . . . . . F-4 Alarm thresholds and linked Ventilation parameters . . . . . . . . . . . . 7-20 Alarms display of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 Level of priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Logs menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3 menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 NO DATA message . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3 overview of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7 re-activating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6 resetting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5 setting parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . 7-20 silencing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4 tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-1 Index-1 Index thresholds, blocking when linked to a ventilation parameter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22 Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14 volume, setting of . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12 Alarms and troubleshooting . . . . . . . . . . . . . . . . . . . . . 5-1 Alarms tests continuing pressure . . . . . . . . . . . . . . . . . . . . . . . . . . .F-2 low pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-1 power failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-2 Alarms, utilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Alarms, ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Altitude compensation feature. . . . . . . . . . . . . . . . . . . C-1 Antibacterial filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10 Apnea and ventilation modes . . . . . . . . . . . . . . . . . . . . . . . . D-3 APNEA alarm message . . . . . . . . . . . . . . . . . . . . . .5-7, 5-14 Apnea alarm test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-2 Apnea Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5, 3-8 Audible alarms silencing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4 B Back panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5 Backlight, display setting of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11 Backup R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 Bar chart, pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 Bargraph display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4 Battery heat safety device . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2 BATTERY FAULT1 alarm message. . . . . . . 5-7, 5-14, 8-4 BATTERY FAULT2 alarm message. . . . . . . . . . . .5-7, 5-14 Battery, internal capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1 indicator, front panel (figure). . . . . . . . . . . . . . . . . . 8-2 operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2 reserve capacity display, ventilation running (figure). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3 reserve capacity display, ventilation stopped (figure). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3 reserve capacity, displayed. . . . . . . . . . . . . . . . . . . . 8-2 symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2 Beep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4 Blocking an alarm threshold . . . . . . . . . . . . . . . . . . . . 7-22 Breath types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1 Breathing Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6 BUZZER FAULT1 alarm message. . . . . . . . . . . . .5-7, 5-15 BUZZER FAULT2 alarm message. . . . . . . . . . . . .5-7, 5-15 BUZZER FAULT3 alarm message. . . . . . . . . . . . .5-7, 5-15 BUZZER FAULT4 alarm message. . . . . . . . . . . . .5-8, 5-15 BUZZER LOW BATTERY alarm message . . . . . .5-7, 5-15 C Capacity of the battery. . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1 Carbon dioxide risk of inhalation and suffocation . . . . . . . . . . . . . 7-29 Index-2 Carrying bag, ventilator (figure) . . . . . . . . . . . . . . . . . . G-1 Changing ventilation modes . . . . . . . . . . . . . . . . . . . . 7-16 CHECK BATTERY CHARGE alarm message . . . 5-8, 5-15 CHECK EXH VALVE alarm message. . . . . . . . . . 5-8, 5-15 CHECK EXH VALVE PRESSURE alarm message5-8, 5-15 CHECK PROXIMAL LINE1 alarm message . . . . 5-8, 5-16 CHECK REMOTE ALARM alarm message . . . . 5-8, 5-16 CHECK SETTINGS alarm message . . . . . . . . . . . 5-8, 5-16 Classification of device . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 Cleaning accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2 solutions and products, approved . . . . . . . . . . . . . 9-1 ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1 Clinician responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1 CONNECT VALVE OR CHANGE PRESS alarm message . . 5-9, 5-16 Connecting to AC power. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2 DC power. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4 oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13 oxygen supply (figure) . . . . . . . . . . . . . . . . . . . . . . . 6-14 the oxygen supply . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13 Consumables replacement intervals . . . . . . . . . . . . . . . . . . . . . . . . 10-2 Continuing pressure test . . . . . . . . . . . . . . . . . . . . . . . . . F-2 Contraindications against use of ventilator. . . . . . . . . . . . . . . . . . . . . . . 2-2 Contrast (display), setting . . . . . . . . . . . . . . . . . . . . . . . 7-11 CONTROLLED CYCLES alarm message . . . . . . 5-9, 5-16 Cooling fan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1 COOLING FAN alarm message. . . . . . . . . . . . . . 5-9, 5-16 CPAP mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6 CPAP Mode Menu Alarm parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7 D DC power cable connecting to ventilator. . . . . . . . . . . . . . . . . . . . 6-5 disconnecting from ventilator . . . . . . . . . . . . . . 6-6 connecting to. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4 DC POWER DISCONNECTION alarm message5-9, 5-16, 6-6 Device classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 DEVICE FAULT 11 alarm message. . . . . . . . . . . . . . . . . 5-9 DEVICE FAULT10 alarm message . . . . . . . . . . . 5-9, 5-17 DEVICE FAULT11 alarm message . . . . . . . . . . . 5-9, 5-17 DEVICE FAULT12 alarm message . . . . . . . . . . . 5-9, 5-17 DEVICE FAULT13 alarm message . . . . . . . . . . . . . . . . . 5-9 DEVICE FAULT3 alarm message . . . . . . . . . . . . 5-9, 5-16 DEVICE FAULT5 alarm message . . . . . . . . . . . . 5-9, 5-16 DEVICE FAULT7 alarm message . . . . . . . . . . . . 5-9, 5-16 DEVICE FAULT9 alarm message . . . . . . . . . . . . 5-9, 5-17 Digital monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 Display Clinician’s Manual Index of alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 setting the backlight . . . . . . . . . . . . . . . . . . . . . . . . . 7-11 setting the contrast . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11 Display, bargraph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4 Displayed parameters monitored . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3 Dual Bag (figure). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-2 E E Sens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 Electromagnetic compatibility and mobile/portable communications equipment 6-2 Electromagnetic emissions and use of accessories . . . . . . . . . . . . . . . . . . . . . . . . 6-2 EMPTY BATTERY alarm message. . . . . . 5-10, 5-17, 8-3 Environment suitable for use of ventilator. . . . . . . . . . . . . . . . . . . 2-1 Environmental specifications. . . . . . . . . . . . . . . . . . . . . B-7 Erase Data, USB Memory Device . . . . . . . . . . . . . . . . . 7-26 F FAA requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 Faults, technical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10 air inlet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10 antibacterial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10 FIO2 oxygen and ventilator settings . . . . . . . . . . . . . . . 3-13 Front panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4 G Gas delivery system (diagram). . . . . . . . . . . . . . . . . . . . C-2 H Heat safety device, battery . . . . . . . . . . . . . . . . . . . . . . . 6-2 HIGH INT TEMP COOL VENT alarm message 5-10, 5-17 HIGH LEAKAGE alarm message . . . . . . . . . . . . 5-10, 5-18 HIGH PRESSURE alarm message . . . . . . . . . . . 5-10, 5-19 HIGH RATE alarm message . . . . . . . . . . . . . . . . 5-10, 5-19 HIGH VTI alarm message . . . . . . . . . . . . . . . . . . 5-10, 5-18 HIGH/LOW BATTERY TEMP alarm message. 5-10, 5-18 Holes, air circulation . . . . . . . . . . . . . . . . . . . . . . . . .1-2, 6-1 Hot surfaces ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-30 Humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-11 I I E (I/T). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11 I Sens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-3, 3-8, 3-11 I/O switch (figure). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 I/T (I E). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11 Ignition sources (warning) . . . . . . . . . . . . . . . . . . . . . . . 6-1 Indications for use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 Clinician’s Manual Indicator VENT STDBY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 Indicator and alarm specifications . . . . . . . . . . . . . . . . B-3 Indicators AC power. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4 INTERNAL BATTERY . . . . . . . . . . . . . . . . . . . . . . .8-2, 8-4 Inhalation port closeup (figure) . . . . . . . . . . . . . . . . . . 6-8 Inspiratory Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11 Inspiratory Tidal Volume . . . . . . . . . . . . . . . . . . . . .3-6, 3-8 Inspiratory trigger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2 Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 placing the ventilator . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 Installation and Assembly . . . . . . . . . . . . . . . . . . . . . . . . 6-1 INTENTIONAL VENT STOP alarm message. . 5-11, 5-19 Internal battery charging (Warning) . . . . . . . . . . . . . . . . . . . . . . .6-2, 8-4 maintenance (none required) . . . . . . . . . . . . . . . . 10-3 recharging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4 replacement interval . . . . . . . . . . . . . . . . . . . . . . . . . 10-3 storing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5 test interval. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3 testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4, F-3 INTERNAL BATTERY indicator. . . . . . . . . . . . . . . . . . . . . 8-4 Involuntary stop test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-4 K Key sound setting of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13 Keyboard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6 locking of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27 unlocking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27 KEYPAD FAULT alarm message . . . . . . . . . . . . 5-11, 5-19 Keys VENTILATION ON/OFF. . . . . . . . . . . . . . . . . . . . . . . . . 7-2 L Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14 Linked ventilation parameters setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-20 Liquids avoid ingress into ventilator (Warning) . . . . . . . . 1-2 Locking key disabling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27 enabling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27 Locking Key and SETUP menu . . . . . . . . . . . . . . . . . . . . 7-3 Locking the keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27 Logs menu alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3 LOW BATTERY alarm message. . . . . . . . .5-11, 5-19, 8-3 Low pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-1 LOW VTl alarm message . . . . . . . . . . . . . . . . . . 5-11, 5-19 M Machine counter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 Maintenance configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3 Index-3 Index option reserved for service personnel. . . . . . . . . . . . . . 7-8 schedule, recommended. . . . . . . . . . . . . . . . . . . . . 10-2 Manufacturer’s declaration specifications . . . . . . . . B-9 Markings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11, 1-14 Max Leak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6, 3-8, 3-12 Max P (Maximum Inspiration Pressure) . . . . . . . . . . . 3-5 Max P (Maximum inspiration pressure) . . . . . . . . . . 3-12 Max Rtot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6, 3-8, 3-12 Maximum inspiration pressure . . . . . . . . . . . . . .3-5, 3-12 Menu alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 Preferences, parameters . . . . . . . . . . . . . . . . . . . . . . 7-9 ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 Min/Max I Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5 Modes ventilation setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15 Modes of Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1 Monitored parameters displayed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3 specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3 Waveform menu (figure) . . . . . . . . . . . . . . . . . . . . . . 4-2 Monitoring, digital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 N NO DATA message, Alarm Logs screen . . . . . . . . . . . 5-3 NO PROXIMAL LINE2 alarm message . . . . . . 5-11, 5-20 Notes definition of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 Nurse Call cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-18 Nurse call system connecting the cable to the ventilator . . . . . . . . 6-18 O OCCLUSION CHECK CIRCUIT alarm message5-11, 5-20 OCCULSION CHECK CIRCUIT alarm message . . . . . 5-20 Operational verification checklist. . . . . . . . . . . . . . . . . .E-1 Operator/Users targeted for use of ventilator . . . . . . . . . . . . . . . . . . 2-1 O-ring, oxygen coupler (Caution). . . . . . . . . . . . . . . . 6-13 Oxygen connecting the supply . . . . . . . . . . . . . . . . . . . . . . . 6-13 connector stud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13 disconnecting the supply from the ventilator . 6-14 enrichment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2 rear panel connector (figure) . . . . . . . . . . . . . . . . . 6-13 special coupler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13 supply connection . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13 using medical-grade only (Warning). . . . . . . . . . 6-13 P P A/C mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 P A/C Mode Menu Alarm parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10 P Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3 Index-4 Parameters alarms, setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-20 ventilation modifying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-19 setting of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-19 Parameters, operating CPAP mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6 Apnea Time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 Inspiratory Tidal Volume (VTI) . . . . . . . . . . . . . . 3-8 Inspiratory Trigger Sensitivity (I Sens) . . . . . . . 3-8 Max Leak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 Max Rtot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 Positive End Expiratory Pressure (PEEP) . . . . . 3-7 P A/C mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 I E (I/T) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11 I Sens (Inspiratory Sensitivity). . . . . . . . . . . . . . 3-11 Inspiratory Tidal Volume (VTI) . . . . . . . . . . . . . 3-12 Max Leak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12 Max Rtot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12 Peak inspiratory pressure (PIP). . . . . . . . . . . . . 3-10 Positive End Expiratory Pressure (PEEP) . . . . 3-10 Respiratory Rate (Rate) . . . . . . . . . . . . . . . . . . . . 3-11 Rise Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10 VT Target (Target Tidal Volume) . . . . . . . . . . . 3-12 P A/C mode Max P (Maximum inspiration pressure) 3-12 PSV mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 Apnea Time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5 Backup R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 Inspiratory Tidal Volume (VTI) . . . . . . . . . . . . . . 3-6 Inspiratory Trigger Sensitivity (I Sens) . . . . . . . 3-3 Max Leak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6 Max P (Maximum Inspiration Pressure). . . . . . 3-5 Max Rtot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6 Min/Max Inspiration Time (Min I Time/Max I Time). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5 Positive End Expiratory Pressure (PEEP) . . . . . 3-3 Pressure Support (P Support) . . . . . . . . . . . . . . . 3-3 Rise Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3 VT Target (Target Tidal Volume) . . . . . . . . . . . . 3-5 PSV mode Exhalation sensitivity (E Sens) Exhalation Sensitivity . . . . . . . . . . . . . . . . . . . . . . 3-4 VT Target (Target Tidal Volume) . . . . . . . . . . . . . . . 3-5 Parts and accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . H-1 Patient outlet port connections (figure) . . . . . . . . . . . . . . . 6-8 Patient circuit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6 attaching to ventilator . . . . . . . . . . . . . . . . . . . . . . . . 6-6 choosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6 installing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7 length and internal volume . . . . . . . . . . . . . . . . . . . 6-9 replacement interval . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 single limb, connecting . . . . . . . . . . . . . . . . . . .6-7, 6-8 Patient counter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 PATIENT DISCONNECTION alarm message . 5-12, 5-20 Patient hours changing the setting of . . . . . . . . . . . . . . . . . . . . . . . 7-7 Clinician’s Manual Index Patient/Caregiver Checklist . . . . . . . . . . . . . . . . . . . . . . A-1 Patients targeted for use of ventilator . . . . . . . . . . . . . . . . . . 2-1 Peak inspiratory flow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 Peak inspiratory pressure . . . . . . . . . . . . . . . . . . . . . . . 3-10 PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3, 3-7, 3-10 Performance specifications. . . . . . . . . . . . . . . . . . . . . . . B-3 Physical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 PIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10 Placing the ventilator (installing) . . . . . . . . . . . . . . . . . 6-1 Pneumatic specifications. . . . . . . . . . . . . . . . . . . . . . . . . B-8 Positive end expiratory pressure . . . . . . . . . . . . . . . . 3-10 Power failure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-2 POWER FAULT alarm message. . . . . . . . . . . . . 5-12, 5-20 Power On Self Test (POST). . . . . . . . . . . . . . . . . . . . . . . . 7-2 POWER SUPPLY LOSS alarm message. . . . . . 5-12, 5-20 Precautions for use electromagnetic interference. . . . . . . . . . . . . . . . . 1-11 Precautions for use, cautions general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 installation environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 Precautions for use, warnings general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 Preference menu changing the settings in . . . . . . . . . . . . . . . . . . . . . 7-10 displaying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9, 7-23 PRES SENS FLT1 alarm message . . . . . . . . . . . 5-12, 5-20 Pressure bar chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 Principles of operation . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1 Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-21 PROX SENS FLT2 alarm message. . . . . . . . . . . 5-12, 5-20 PSV mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 PSV Mode Menu Alarm parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2 R Range, resolution, and accuracy specifications . . . . B-5 Rate (Respiratory Rate) . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11 Reactivating alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6 Recharging the internal battery . . . . . . . . . . . . . . . . . . 8-4 REMOVE VALVE CPAP MODE alarm message . . . . .5-12, 5-21 REMOVE VALVE OR CHANGE PRES alarm message . . . 5-13, 5-20 Repairing the ventilator qualified personnel only (Warning) . . . . . 10-1, 10-2 Replacement intervals air inlet filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 air outlet (antibacterial) filter . . . . . . . . . . . . . . . . . 10-2 consumables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 patient circuit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 Clinician’s Manual Replacing air inlet filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1 Resetting alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5 RESTART. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9 Rise Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3, 3-10 Risk of fire (warning) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 S Safety onboard alarm system . . . . . . . . . . . . . . . . . . . . . . . . 2-2 Service assistance information . . . . . . . . . . . . . . . . . . 10-3 Setting ventilation parameters . . . . . . . . . . . . . . . . . . 7-19 Setup Configuration SETUP menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3 SETUP screen changing parameters . . . . . . . . . . . . . . . . . . . . . . . . . 7-4 screen shot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3 SOFTWARE VERSION ERROR alarm message5-13, 5-21 Specifications electrical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7 indicators and alarms . . . . . . . . . . . . . . . . . . . . . . . . . B-3 manufacturer’s declaration. . . . . . . . . . . . . . . . . . . . B-9 monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . B-3 performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3 physical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 pneumatic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-8 range, resolution, and accuracy . . . . . . . . . . . . . . . B-5 standards compliance and IEC classification . . B-13 ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 Standards, compliance, and IEC classification specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-13 Starting ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-28 Stopping ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-29 Storing the internal battery . . . . . . . . . . . . . . . . . . . . . . 8-5 Stud, oxygen connector. . . . . . . . . . . . . . . . . . . . . . . . . 6-13 T Target Tidal Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5 Target tidal volume . . . . . . . . . . . . . . . . . . . . . . . . 3-5, 3-12 Technical faults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Testing internal battery . . . . . . . . . . . . . . . . . . . . . . . . . . .8-4, F-3 Transfer continuously, USB Memory Device. . . . . . 7-23 Transfer Trends USB Memory Device . . . . . . . . . . . . 7-24 Transport, emergency ventilator not intended for . . . . . . . . . . . . . . . . . . . . 2-2 Trigger threshold setting modifying (Caution) . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 Troubleshooting alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14 other problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-21 TURB OVERHEAT alarm message . . . . . . . . . . 5-13, 5-21 Turning off the ventilator . . . . . . . . . . . . . . . . . . . . . . . 7-30 Turning on the ventilator . . . . . . . . . . . . . . . . . . . . . . . . 7-1 Index-5 Index U UNKNOWN BATTERY alarm message . . . . . . 5-13, 5-21 Unlocking the keyboard . . . . . . . . . . . . . . . . . . . . . . . . 7-27 Unpacking and preparing the ventilator. . . . . . . . . . G-1 USB Memory Device Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Erase Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-26 Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Supported formats . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Transfer continuously . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Transfer Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-24 USB Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 USB Menu parameters . . . . . . . . . . . . . . . . . . . . . . . 7-22 VTI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-6, 3-8, 3-12 W Warnings definition of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 general list of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preface-1 Waveform menu monitored parameters (figure) . . . . . . . . . . . . . . . . 4-2 Welcome Menu screen display of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 skipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3 Wheelchair mounting the ventilator onto . . . . . . . . . . . . . . . . 6-16 V VENT STDBY indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 Ventilation menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 starting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-28 stopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-29 Ventilation modes . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2, D-1 and apnea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-3 changing during ventilation . . . . . . . . . . . . . . . . . 7-16 changing while on standby . . . . . . . . . . . . . . . . . . 7-16 setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15 VENTILATION ON/OFF key . . . . . . . . . . . . . . . . . . . . . . . 7-2 Ventilation parameters digital monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 modifying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-19 setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-19 setting when linked to alarm thresholds . . . . . . 7-20 setting when linked to other parameters . . . . . 7-20 Ventilator architecture of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1 carrying bag (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . G-1 cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1 connecting the nurse call cable . . . . . . . . . . . . . . 6-18 connections, proper (warning) . . . . . . . 1-2, 6-1, 6-6 failure of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9 filters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10 mounting on a wheelchair . . . . . . . . . . . . . . . . . . . 6-16 operation (description of) . . . . . . . . . . . . . . . . . . . . . C-1 parts and accessories . . . . . . . . . . . . . . . . . . . . . . . . . H-1 patient outlet port connections (figure) . . . . . . . 6-8 potentially hot surfaces . . . . . . . . . . . . . . . . . . . . . . 7-30 principles of operation . . . . . . . . . . . . . . . . . . . . . . . . C-1 specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 symbols and markings . . . . . . . . . . . . . . . . . . . . . . . 1-11 turning off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-30 turning on. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1 unpacking and preparation . . . . . . . . . . . . . . . . . . . G-1 Ventilator, and liquid ingress (Warning) . . . . . . . . . . 1-2 Volume, alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12 VT Target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12 Vt Target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-4 VT Target (Target Tidal Volume) . . . . . . . . . . . . . . . . . . 3-5 Index-6 Clinician’s Manual 10056026 Rev C 03/2012 COVIDIEN, COVIDIEN with logo and Covidien logo are U.S. and/or internationally registered trademarks of Covidien AG. ™ Trademarks of a Covidien company. ™* Trademarks of their respective owner. © 2012 Covidien. Covidien llc, 15 Hampshire Street, Mansfield, MA 02048 USA. Covidien Ireland Limited, IDA Business & Technology Park,Tullamore. www.covidien.com [T] 1-800-635-5267 ">

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Key features
- Portable and lightweight
- Variety of ventilation modes
- Safety features
- Easy-to-use
- Internal battery
- Digital monitoring
- Alarm log menu
Frequently asked questions
The Puritan Bennett 520 ventilator offers three ventilation modes: Assist/Control (A/C), CPAP, and PSV.
The Puritan Bennett 520 ventilator has many safety features, including alarms for high and low pressure, low battery, and disconnection.
The Puritan Bennett 520 ventilator has an internal battery that can be used to power the device for up to 8 hours. To charge the battery, connect the ventilator to an AC power source.