System Operating Manual
System Operating Manual
For use with Lists:
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Prime
12391-04 & 11971-04
A
Hospira, Inc., 275 North Field Drive
Lake Forest, IL 60045, USA
B
Options/
Vol Inf
430-95491-006 (A, 2015-06)
ii
Change History
Change History
Description of
Changes
Section
430-95491-003
(Rev. 03/06)
Third Release
All
430-95491-005
(Rev. 2013-02)
Replaced ® with ™,
removed copyright
and trademark
statements,
updated regulatory
symbols
All
Added precaution to
prevent unrestricted
flow
1 and 2
Rewrote air bubble
precaution and air
filter
recommendation.
Added low flow rate
range
1
Updated alarm
volume instructions
3
Added
administration set
graphic and warning
to prevent
unrestricted flow
4
Added instructions
for closing clamps
4 and 5
Updated air in line
alarm distal and
cumulative bolus
amounts
9
Title
System Operating Manual
Change History
iii
Title
Description of
Changes
430-95491-006
(A, 2015-06)
Deleted "All Rights
Reserved"
TOC
Updated "Technical
Support Operations"
to "Advanced
Knowledge Center"
10 and inside
back cover
Revised power
requirements,
generalized fuse
information, and
added low flow rate
delivery accuracy
statement
9
System Operating Manual
Section
iv
Change History
NOTES
System Operating Manual
Plum A+ Infusion System
v
Contents
1) DESCRIPTIVE INFORMATION. . . . . . . . . . . . . . . . 1-1
1.1 PRODUCT DESCRIPTION . . . . . . . . . . . . . . . . . . . . 1-2
1.2 INDICATIONS FOR USE . . . . . . . . . . . . . . . . . . . . . 1-2
USER QUALIFICATION . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2
1.3 CONVENTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
WARNINGS, CAUTIONS, AND NOTES . . . . . . . . . . . . . . . 1-4
1.4 PRECAUTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
ARTIFACTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
HEALTHCARE PROFESSIONALS AND PATIENT RELATED . 1-6
CONCURRENT FLOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8
EPIDURAL ADMINISTRATION . . . . . . . . . . . . . . . . . . . . . 1-10
BATTERY OPERATION . . . . . . . . . . . . . . . . . . . . . . . . . 1-11
SETS AND ACCESSORIES . . . . . . . . . . . . . . . . . . . . . . 1-11
BACKPRIMING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12
GENERAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12
CLEANING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
BOLUS RELATED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14
2) PRINCIPLES OF OPERATION . . . . . . . . . . . . . . . . 2-1
2.1 FEATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
THERAPIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LINE PROGRAMMING OPTIONS . . . . . . . . . . . . . . . . . . .
PLUMSET CAPABILITIES . . . . . . . . . . . . . . . . . . . . . . . . .
AIR MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BATTERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BIOMEDICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OPTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OTHER FEATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2-1
2-1
2-2
2-2
2-2
2-2
2-2
2-3
2.2 DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
System Operating Manual
vi
Contents
3) EQUIPMENT DESCRIPTION . . . . . . . . . . . . . . . . .
3.1 OPERATING KEYS . . . . . . . . . . . . . . . . . . . . . . . .
3.2 INDICATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.3 DISPLAY SYMBOLS . . . . . . . . . . . . . . . . . . . . . . . .
3.4 REAR CASE CONTROLS . . . . . . . . . . . . . . . . . . . .
3.5 ADMINISTRATION SETS . . . . . . . . . . . . . . . . . . . . .
PREPARING THE ADMINISTRATION SET . . . . . . . . . . . .
PRIMING THE ADMINISTRATION SET . . . . . . . . . . . . . .
LOADING THE CASSETTE . . . . . . . . . . . . . . . . . . . . . .
PREPARING THE SECONDARY LINE . . . . . . . . . . . . . . .
3-1
3-2
3-5
3-6
3-7
3-9
3-10
3-11
3-11
3-12
3.6 DISCONTINUING ELECTRONIC FLOW CONTROL
AND SETTING GRAVITY FLOW . . . . . . . . . . . . . . . . . . 3-14
3.7 DISCONTINUING FLUID ADMINISTRATION . . . . . . . 3-15
4) BASIC OPERATION . . . . . . . . . . . . . . . . . . . . . . . . 4-1
4.1 GETTING STARTED. . . . . . . . . . . . . . . . . . . . . . . . 4-1
UNPACKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TANDEM CARRIER INSTRUCTIONS . . . . . . . . . . . . . . . . .
SYSTEM SELF-TESTS . . . . . . . . . . . . . . . . . . . . . . . . . .
DATA RETENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4-1
4-2
4-2
4-4
4.2 POWER ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4
4.3 SIMPLE DELIVERY . . . . . . . . . . . . . . . . . . . . . . . . 4-6
4.4 TITRATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9
4.5 PIGGYBACK DELIVERY . . . . . . . . . . . . . . . . . . . . 4-13
4.6 CONCURRENT DELIVERY . . . . . . . . . . . . . . . . . . 4-16
4.7 STOP AND START WITH ONLY 1 LINE PUMPING . . 4-19
4.8 STOP AND START WITH BOTH LINES PUMPING . . 4-20
4.9 BACKPRIMING . . . . . . . . . . . . . . . . . . . . . . . . . . 4-22
4.10 CLEARING SETTINGS . . . . . . . . . . . . . . . . . . . . 4-23
5) THERAPIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1
5.1 DOSE CALC (MCG/KG/MIN ON A). . . . . . . . . . . . . . 5-2
5.2 DOSE CALC (MG/MIN ON B) . . . . . . . . . . . . . . . . . 5-9
5.3 LOADING DOSE . . . . . . . . . . . . . . . . . . . . . . . . . 5-15
5.4 MULTISTEP PROGRAMMING . . . . . . . . . . . . . . . . 5-23
System Operating Manual
Plum A+ Infusion System
vii
6) ADDITIONAL FEATURES . . . . . . . . . . . . . . . . . . . 6-1
6.1 SIMPLE DELIVERY USING DELAYED START . . . . . . 6-1
6.2 PIGGYBACK WITH NURSE CALLBACK . . . . . . . . . . . 6-3
6.3 POSSIBLE NON-DELIVERY PROGRAMMED . . . . . . . 6-4
6.4 USING THE STANDBY FEATURE . . . . . . . . . . . . . . . 6-5
6.5 SELECT OPTION- VOLUMES INFUSED,
PRESSURE/POST INFUSION RATE,
AND LIGHTING/CONTRAST . . . . . . . . . . . . . . . . . . . . . . 6-6
6.6 VARIABLE RATE CAP . . . . . . . . . . . . . . . . . . . . . 6-10
6.7 EXAMPLES OF AUTOMATIC CALCULATION . . . . . . 6-10
AT STARTUP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10
WHILE RUNNING (TITRATION) . . . . . . . . . . . . . . . . . . . 6-10
AT KVO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-11
7) ALARMS AND TROUBLESHOOTING . . . . . . . . . . 7-1
7.1 WARNING MESSAGES . . . . . . . . . . . . . . . . . . . . . . 7-1
7.2 RESPONSE TO ALARMS . . . . . . . . . . . . . . . . . . . . 7-2
GENERAL ALARMS . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LINE A ALARMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LINE B ALARMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MALFUNCTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7-3
7-5
7-7
7-8
7.3 GENERAL MESSAGES . . . . . . . . . . . . . . . . . . . . . . 7-9
8) CLEANING, MAINTENANCE,
AND STORAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1
CLEANING AND SANITIZING . . . . . . . . . . . . . . . . . . . . . .
BATTERY MAINTENANCE . . . . . . . . . . . . . . . . . . . . . . . .
STORAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SERVICE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
System Operating Manual
8-1
8-3
8-4
8-4
viii
Contents
9) SPECIFICATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . 9-1
PHYSICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ELECTRICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
VTBI RANGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ENVIRONMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DELIVERY RATE RANGE . . . . . . . . . . . . . . . . . . . . . . . .
AIR-IN-LINE ALARM . . . . . . . . . . . . . . . . . . . . . . . . . . .
OCCLUSION ALARM AND LIMITS . . . . . . . . . . . . . . . . . .
TIME TO DETECT DOWNSTREAM OCCLUSIONS . . . . . . .
BOLUS VOLUME RELEASED AFTER DOWNSTREAM
OCCLUSIONS ARE CORRECTED . . . . . . . . . . . . . . . . . .
DELIVERY ACCURACY . . . . . . . . . . . . . . . . . . . . . . . . .
ENTERAL AND HIGH VISCOSITY FLUIDS EFFECTS . . . . .
TRUMPET CURVES . . . . . . . . . . . . . . . . . . . . . . . . . . . .
EXAMPLE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9-1
9-1
9-2
9-2
9-2
9-3
9-3
9-3
9-4
9-4
9-5
9-6
9-6
10) SUPPLIES AND ACCESSORIES. . . . . . . . . . . . . 10-1
10.1 ADMINISTRATION FLUIDS . . . . . . . . . . . . . . . . . 10-1
ADMINISTRATION FLUIDS . . . . . . . . . . . . . . . . . . . . . . 10-1
ENTERAL AND HIGH VISCOSITY FLUIDS. . . . . . . . . . . . 10-1
CONTAINERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1
10.2 ACCESSORIES . . . . . . . . . . . . . . . . . . . . . . . . . 10-2
GENERAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2
PC BASED APPLICATION . . . . . . . . . . . . . . . . . . . . . . 10-2
11) WARRANTY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1
12) DEFAULT DRUG LIBRARY . . . . . . . . . . . . . . . . . 12-1
System Operating Manual
Plum A+ Infusion System
1)
1- 1
Descriptive Information
The Plum A+TM Volumetric Infusion System is designed to meet
the fluid delivery requirements of today’s evolving healthcare
environments. The pump is a cassette based multi-function
infusion system. The Plum A+ allows two lines in and one line
out. The pump can be used for standard, piggyback, or
concurrent delivery. Therapy modes include:
•
Standard Infusions
•
Multistep Programming
•
Loading Dose
•
Dose Calculation
The Plum A+ is designed to deliver parenteral, enteral, or
epidural infusions over a broad range of infusion rates from
multiple fluid container types.
The Plum A+ is designed to be used in most areas of patient
care, including, but not limited to:
•General Floor
•Labor/Delivery/
Post Partum
•Burn Unit
•Medical/Surgical
•OR/Anesthesia
•Hemodialysis
•ICU/CCU
•Post Op/
Recovery
•Oncology
•Pediatrics
•Cardiac Cath
Lab
•Mobile Intensive
Care
•Neonatology
•Emergency
•Nutritional
System Operating Manual
1- 2
1) Descriptive Information
1.1 Product Description
The system includes a pumping module (hereafter called the
pump) and an assortment of disposable IV sets (hereafter called
a set), optional accessories, and this operator’s manual.
Accessory equipment connected to the analog and digital
interfaces must be certified according to the respective IEC
Standards (for example, IEC 60950 for data processing
equipment and IEC 60601-1 for Medical Equipment).
Furthermore, all configurations shall comply with the system
standard IEC 60601-1-1. Any person who connects additional
equipment to the signal input or output part configures a medical
system, and is therefore responsible for ensuring that the system
complies with the requirements of the system Standard IEC
60601-1-1. If in doubt, consult the technical service department
or your local representative.
NOTE: Do not connect to Dataport while infusing.
1.2 Indications for Use
USER QUALIFICATION
The Plum A+ is intended for use at the direction or under the
supervision of licensed physicians or certified healthcare
professionals who are trained in the use of the pump and the
administration of parenteral, enteral, and epidural fluids and
drugs and whole blood or red blood cell components. The training
should emphasize preventing related IV complications, including
appropriate precautions to prevent accidental infusion of air. The
epidural route can be used to provide anesthesia or analgesia.
System Operating Manual
Plum A+ Infusion System
1- 3
WARNING
ADMINISTER ONLY ANESTHETICS/ANALGESICS
APPROVED FOR EPIDURAL ADMINISTRATION (AS
INDICATED OR ALLOWED BY THE DRUGS’ FDA
APPROVED LABELING). EPIDURAL ADMINISTRATION
OF DRUGS OTHER THAN THOSE INDICATED FOR
EPIDURAL USE COULD RESULT IN SERIOUS INJURY TO
THE PATIENT.
1.3 Conventions
This section describes the conventions used throughout this
manual, as follows:
CONVENTION
APPLICATION
EXAMPLE
Italic
Reference to a
section, figure, or
table
(See Figure 3-1,
Priming
Cassette)
Function or mode
specific instructions
Primary Only:
Attach an empty
container.
Keys or buttons on
the device are
displayed in
[BRACKETED ALL
CAPS] or with a
graphic.
[START]
 [Italic]
Softkey Options
 [Choose]
Initial Caps
lowercase
Screen displays and
device labels (as
appropriate)
Therapy
[BRACKETED
ALL CAPS]
System Operating Manual
or
Dose Calculation
1- 4
1) Descriptive Information
CONVENTION
APPLICATION
EXAMPLE
Bold
Emphasis
...sets are
supplied Sterile
and are for....
WARNINGS, CAUTIONS, AND NOTES
Alert messages used throughout this manual are described
below. Pay particular attention to these messages.
WARNING
A WARNING MESSAGE CONTAINS SPECIAL SAFETY
EMPHASIS AND MUST BE OBSERVED AT ALL TIMES.
FAILURE TO OBSERVE A WARNING MESSAGE IS
POTENTIALLY LIFE THREATENING.
CAUTION: A CAUTION USUALLY APPEARS IN FRONT OF
A PROCEDURE OR STATEMENT. IT CONTAINS INFORMATION
THAT COULD PREVENT IRREVERSIBLE PRODUCT DAMAGE OR
HARDWARE FAILURE. FAILURE TO OBSERVE A CAUTION
COULD RESULT IN SERIOUS PATIENT OR USER INJURY.
NOTE: A Note highlights information that helps explain a
concept or procedure.
This symbol directs the user to consult accompanying
documents.
When visible on the display, this symbol informs the
user to use CAUTION because the specified drug has
NOT been programmed with specified safety limits.
NOTE: Figures are rendered as graphic representations
to approximate the actual product. Therefore, figures
may not exactly reflect the product.
System Operating Manual
Plum A+ Infusion System
1- 5
1.4 Precautions
The Plum A+ has been designed and manufactured to be safe,
reliable, and easy to use. This section details precautions and
possible hazards.
For safe operation of the Plum A+, observe the following
precautions and hazards.
ARTIFACTS
•
Nonhazardous, low-level electrical potentials are
commonly observed when fluids are
administered using infusion devices. These
potentials are well within accepted safety
standards, but may create artifacts on voltagesensing equipment such as ECG, EMG, and EEG
machines. These artifacts vary at a rate that is
associated with the infusion rate. If the
monitoring machine is not operating correctly or
has loose or defective connections to its sensing
electrodes, these artifacts may be accentuated
so as to simulate actual physiological signals. To
determine if the abnormality in the monitoring
equipment is caused by the infusion device
instead of some other source in the environment,
set the infusion device so that it is temporarily
not delivering fluid. Disappearance of the
abnormality indicates that it was probably
caused by the electronic noise generated by the
infusion device. Proper setup and maintenance
of the monitoring equipment should eliminate the
artifact. Refer to the appropriate monitoring
equipment system documentation for setup and
maintenance instructions.
•
The Plum A+ system is designed to operate
normally in the presence of most encountered
electromagnetic interference (EMI) conditions. In
System Operating Manual
1- 6
1) Descriptive Information
the event of extreme levels of interference, such
as encountered next to an electrosurgical
generator, it is possible that the normal operation
of a sensor or microcomputer might be
disrupted. Even in this event, the outcome would
likely be a false alarm or detected system
malfunction and would not result in a hazard to
patient or operator.
•
Use of radio frequency emitting devices such as
cellular telephones and 2-way radios in close
proximity of this device may affect its operation.
HEALTHCARE PROFESSIONALS AND PATIENT
RELATED
•
In vitro studies have suggested that packed red
blood cells with unusually high hematocrit be
diluted with blood-compatible fluids, such as
0.9% sodium chloride injection, to decrease
hemolysis and increase flow rate.
•
Setting the primary rate greater than the
secondary rate will result in a more rapid infusion
of any residual secondary drug remaining in the
line and the cassette.
•
Consult drug labeling to confirm drug
compatibility, concentration, delivery rates, and
volumes are all suitable for secondary,
concurrent and piggyback delivery modes.
•
Arrange tubing, cords, and cables to minimize
the risk of patient strangulation or entanglement.
•
Before opening the door, close clamp on the
primary line or remove the secondary container
from the secondary port to prevent mixing of
primary and secondary fluids.
•
To prevent unrestricted flow, close all slide or
CAIR™ clamps before opening the cassette door.
•
Although unlikely, failure of certain robust
mechanical components such as the anti-free
System Operating Manual
Plum A+ Infusion System
1- 7
flow mechanism or valve control springs could
cause fluid delivery limited to the contents of the
fluid container. Single fault failure of certain
electronic/motor control components would
result in no more than 5 mL of unexpected fluid
delivery.
•
A small amount of fluid is expelled from the set
(less than 0.05 mL) each time the door is opened
or closed with a set installed. If potent drugs are
being used, take appropriate action to guard
against overmedication of the patient.
•
Before disconnecting a syringe from the
cassette, pull up the plunger slightly to avoid
spilling the fluid. For rigid containers, close the
upper slide clamp, open the cassette door, then
remove and invert the cassette (ports down).
•
Air bubbles may form distal to the cassette as a
result of normal outgassing of dissolved air in
the fluid in one or more of the following cases:
• Chilled solution is in use
• Certain fluids known to routinely outgas are in
use
• The infuser is mounted significantly above the
patient
• The infuser is infusing at very low rates
between 0.1– 5 mL/hr
In these cases an air-eliminating filter may be used
when clinically appropriate.
•
Repeated opening and closing of the door may
defeat the proximal air-in-line alarm and may
cause a distal air-in-line alarm, requiring
repriming.
•
The screen displays the VTBI (volume to be
infused) in integers when value is above 99.9.
Any fraction of a milliliter delivered is not
displayed, but is retained in memory.
System Operating Manual
1- 8
1) Descriptive Information
CONCURRENT FLOW
GUIDELINES
When delivering short half-life critical drugs (see Critical Drugs,
this section) using the Plum A+ in the Concurrent mode, the
following delivery rate guidelines should be observed:
•
If the critical drug (with half-life less than 6
minutes) is to be infused at less than 2 mL/hr, the
other infusion should be no faster than 5 times
the critical drug’s rate. Dopamine, for example,
delivered at 1.5 mL/hr should not be
accompanied by an infusion programmed any
faster than 7.5 mL/hr.
•
If the critical drug (with half-life less than 6
minutes) is to be infused at 2 to 5 mL/hr the other
infusion should be no faster than ten times the
critical drug’s rate. Dopamine, for example,
delivered at 3.5 mL/hr should not be
accompanied by an infusion programmed any
faster than 35 mL/hr.
•
If the critical drug (with half-life less than 6
minutes) is to be infused at 5.1 mL/hr or greater,
the other infusion can be programmed at any
desired rate.
NOTE: The total of the primary rate plus the secondary
rate cannot exceed 500 mL/hr.
System Operating Manual
Plum A+ Infusion System
1- 9
These guidelines apply only when infusing short half-life critical
drugs in Concurrent mode. Individual patient responses may vary
requiring adjustment of delivery rates.
DELIVERY RATE GUIDELINES
SHORT HALF-LIFE (LESS
THAN 6 MINUTES) CRITICAL
DRUG INFUSION RATE
MAXIMUM RATE OF
ACCOMPANYING INFUSION
0.5 - 1.9 mL/hr
5 Times the Critical Drug Rate
2.0 - 5.0 mL/hr
10 Times the Critical Drug Rate
5.1 or Greater
Any Desired Ratio
CRITICAL DRUGS
Examples of drugs with a short half-life (approximately 6 minutes
or less when given IV) include:
Dobutamine
Lidocaine
Dopamine
Nitroglycerin
Epinephrine
Nitroprusside
Epoprostenol
Norepinephrine
Esmolol
Oxytocin
Isoproterenol
Procainamide
For these drugs, the concurrent flow guidelines should be
followed when the infusion rate of the drug will be 5 mL/hr or less.
NOTE: This list of critical drugs is not intended to be allinclusive of critical drugs or drugs with a short half-life.
The clinician should become familiar with the pharmacodynamics
of any critical drug before administration.
System Operating Manual
1- 10
1) Descriptive Information
This information is presented to inform clinicians of a rare
situation that could be misinterpreted if they are unfamiliar with
this phenomenon.
EPIDURAL ADMINISTRATION
•
Recommended use of the epidural route is to
provide anesthesia or analgesia for periods up to
96 hours.
•
This device can be used to administer only those
anesthetics/analgesics approved for epidural
administration (as indicated or allowed by the
drugs’ FDA approved labeling). Epidural
administration of drugs other than those
indicated for epidural use could result in serious
injury to the patient.
•
For epidural administration, the use of Hospira
catheters, pump sets without Y-sites, and
"epidural" stickers indicating ongoing epidural
administration are recommended.
•
Administration of drugs via the epidural route
should be limited to personnel familiar with
associated techniques and patient management
problems. Proper epidural placement of the
catheter is essential since catheter migration
could result in intravascular or intrathecal
administration. Facilities practicing epidural
administration must be equipped with
resuscitative equipment, oxygen, naloxone, and
other resuscitative drugs. Adequate monitoring
equipment (for example, Oximetry) is
recommended for continuous monitoring of the
patient during epidural administration. Patients
must be observed frequently for side effects in a
fully-equipped and staffed environment for at
least 24 hours following completion of drug
administration by the epidural route. DELAYED
RESPIRATORY DEPRESSION FOLLOWING
CONTINUOUS EPIDURAL ADMINISTRATION OF
System Operating Manual
Plum A+ Infusion System
1- 11
PRESERVATIVE-FREE MORPHINE SULFATE HAS
BEEN REPORTED.
•
The epidural space has 58 openings through
which fluid can exit. Pressure buildup during
administration is transient. However, if a large
volume of fluid is administered over a short time
period, the pressure will take longer to return to
normal. If overdelivery occurs during
administration, observe the patient closely for
signs of spinal cord compression (disorientation,
headache, transient neuralgias) and drug
overdose.
BATTERY OPERATION
•
Do not operate the Plum A+ on patients with the
battery removed. Use of a properly maintained
and charged battery helps confirm proper
operation.
•
The battery may not be fully charged upon
receipt. Connect the pump to AC power for at
least six hours.
•
Use AC power whenever possible. Connect to AC
power during storage to ensure a fully charged
battery for emergencies. If the quality of the earth
grounding source is in doubt, use battery power.
•
If the low-battery alarm sounds, connect the
pump to AC power immediately.
SETS AND ACCESSORIES
•
Only compatible LifeCare PlumSetsTM can be
used with the Plum A+. See individual set
instructions for additional information.
•
Administration sets should be changed per CDC
guidelines or healthcare provider policy. Discard
after use.
•
LifeCareTM IV infusion sets with integral
nonblood filters are not for use in the
System Operating Manual
1- 12
1) Descriptive Information
administration of blood, blood products,
emulsions, suspensions, or any medications not
totally soluble in the solution being administered.
These medications may be administered through
the lower Y-injection site, below the filter.
•
When infusing at low delivery rates (5 mL/hr or
less) the use of thick-walled microbore PlumSets
is recommended. This will reduce the amount of
the fluid bolus that may be delivered when a
distal line occlusion is released.
•
Syringes must be larger than 3 cc. Use a syringe
adapter (List 11986-48) when using syringes
smaller than 10 cc. Some 10cc syringes may
require use of a syringe adapter. Syringes larger
than 10 cc may be attached directly to the
secondary port of the cassette. Use of a syringe
adapter may decrease the occurrence of
proximal occlusion alarms.
•
Use a 19-gauge or larger needle or catheter at the
venipuncture site for viscous fluids if operating
at rates greater than 500 mL/hr.
See Section 10 for information on sets and accessories.
BACKPRIMING
•
Backpriming is not recommended for
reconstituting secondary containers containing
dry powders.
•
To avoid pressurization when backpriming into a
syringe, the user must confirm there is sufficient
empty space to accept the backprimed fluid.
GENERAL
•
Possible explosion hazard exists if used in the
presence of flammable anesthetics.
•
Do not place Plum A+ in service if it fails the selftest.
System Operating Manual
Plum A+ Infusion System
1- 13
•
Do not operate the Plum A+ with the case
opened.
•
Keep the cassette door securely closed while the
pump is not in use, to avoid cassette door
damage.
•
The Hospira MedNet Plug ‘n Play module is not
compatible with custom Dataport software
previously written for the Plum A+ Infuser. Use
ONLY Hospira MedNet software with infusers
using the Hospira MedNet Plug ‘n Play module.
•
Values beyond a fields maximum hard limit will
be displayed as dashes (-- -- --). The user must
clear these fields using the [CLEAR] key prior to
entering new values.
CLEANING
For more information on cleaning the pump, see Section 8,
Cleaning, Maintenance, and Storage.
•
To avoid mechanical or electronic damage, do
not immerse the Plum A+ in any fluids or
cleaning solutions.
•
Do not spray cleaning solutions toward any
opening in the instrument.
•
Certain cleaning and sanitizing solutions may
slowly degrade components made from some
plastic materials. Using abrasive cleaners or
cleaning solutions not recommended by Hospira
may result in product damage. Do not use
compounds containing combinations of
isopropyl alcohol and dimethyl benzyl
ammonium chloride.
•
Never use sharp objects such as fingernails,
paper clips, or needles to clean any part of the
pump.
•
Do not sterilize by heat, steam, ethylene oxide
(ETO), or radiation.
System Operating Manual
1- 14
•
1) Descriptive Information
To avoid pump damage, cleaning solutions
should only be used as directed. The disinfecting
properties of cleaning solutions vary; consult the
manufacturer for specific information.
BOLUS RELATED
Use the following procedure to avoid the administration of a bolus
following a distal occlusion (that is, a closed distal clamp):
•
If a secondary container is in use, clamp
proximal tubing before opening the cassette
door.
•
To prevent unrestricted flow, close all slide or
CAIR clamps before opening the cassette door.
•
Open the cassette door and remove the cassette.
•
Open the flow regulator briefly to dissipate the
pressure and then close it.
•
Eliminate the source of occlusion (closed clamp).
•
Reinsert the cassette and close the cassette
door.
•
Open all clamps and resume infusion.
NOTE: When troubleshooting an occlusion where all
clamps are in the OPEN position, use care to avoid
delivery of a bolus by opening the flow regulator to
release any built-up pressure. Close the clamp between
the cassette and the patient before opening the flow
regulator to relieve the pressure. See Section 7, Alarms
and Troubleshooting, for more information.
System Operating Manual
Plum A+ Infusion System
2)
2- 1
Principles of Operation
2.1 Features
The Plum A+ is a dual-line volumetric infusion system designed
to meet the growing demand for hospital-wide, as well as
alternate site and home healthcare, standardization. With its
primary line, secondary line, and piggyback fluid delivery
capability, the Plum A+ is suited for a wide range of medical/
surgical and critical care applications. Full compatibility with
LifeCare Plum Series administration sets and accessories and
the LifeShieldTM and CLAVETM needleless protection systems,
makes the Plum A+ a convenient and cost-effective infusion
system.
THERAPIES
•
Dose Calculation
•
Loading Dose
•
Multistep Programming
LINE PROGRAMMING OPTIONS
•
Therapy Selection
•
Nurse Callback
•
Delayed Start Setting
•
Drug Label Library
•
Concurrent Delivery
•
Titration
•
Micro 0.1-99.9 mL/hr (in 0.1 mL increments)
Flow Rate Range for Both Lines
•
Macro 100-999 mL/hr (in 1 mL increments)
Flow Rate Range for Both Lines
•
Automated Secondary Drug Delivery (Piggyback)
•
Standby Setting
System Operating Manual
2- 2
2) Principles of Operation
PLUMSET CAPABILITIES
•
Anti Free-Flow Protection
•
Direct Connection for Syringe Delivery
AIR MANAGEMENT
•
Air Trap
•
Air Removal/Backpriming
•
Air Detection-Proximal
•
Air Detection-Distal
BATTERY
•
Battery Gauge
•
Less than 8-Hour Battery Recharge Time
•
Long Battery Life (6 hours) for emergency
backup and temporary portable operation
BIOMEDICAL
•
Serial Communication
•
Upgradability (Field)
•
Variable Rate Cap
•
Alarm History
•
Nurse Call Relay Connector
OPTIONS
•
Volumes Infused (A, B, Total Volume)
•
KVO at Dose End (1 mL/hr or less depending
on delivery rate) or Continue Rate (CR) to
continue at the current rate
•
Variable Distal Pressure Settings
System Operating Manual
Plum A+ Infusion System
2- 3
OTHER FEATURES
•
Nonpulsatile Volumetric Accuracy
•
Microprocessor Control
•
Large Liquid Crystal Display (LCD) Screen
•
Panel Back Illumination on Mains Power
•
Lockout Switch
•
Standard Syringe Use
•
Parenteral and Nonparenteral (Enteral) Fluid
Delivery
•
Blood and Blood Products Delivery
•
Wide Range of Standard and Specialty
Administration Sets
•
Password Protected Keypad Lock
2.2 Definitions
TERM
DEFINITION
Administration
Set
The sterile, disposable assembly with
flexible tubing that connects to a
source fluid container for input to the
Cassette pumping chamber and to
some output device for administration
to the patient.
Alarm
A condition requiring operator
intervention that invokes both audible
and visible alarm indicators.
Confirmation of the condition usually
is required.
Alert
While entering a program, a visual
warning that informs the clinician of
the violation of a hospital-defined rule
set; for example, a dose limit for a
specific drug.
System Operating Manual
2- 4
2) Principles of Operation
TERM
DEFINITION
Alternate Units
Other Dose Rate units that may be
selected: ng/kg/min, mcg/kg/min, mcg/
kg/hr, mcg/min, mcg/hr, mg/min, mg/hr,
mg/kg/hr, grams/hr, mEq/hr, mUn/min,
units/min, units/hr, and units/kg/hr.
Alternate Units
Parameters
Drug Amount, Diluent, Patient Weight
(if applicable), and Dose Rate.
Backpressure
Resistance to fluid flow on the Distal or
output portion of the Administration
Set, usually expressed as PSIG.
Backprime
Removal of air or fluid from the
proximal tubing and Cassette air trap
by rapid pumping of fluid from Line A
to an output receptacle on Line B. No
fluid is delivered distal to the cassette
during a Backprime.
Basic Delivery
A single-step delivery specifying rate,
VTBI, and duration only. Drug name
may or may not be specified.
Biomed Mode
The name for the non-delivery or
service mode of Infuser operation,
based on the typical label for hospital
technicians (Biomeds) that have
access to delivery parameter limits and
display default settings. The Biomed
technician downloads the Custom
Drug Library to the Infuser while the
Infuser is in the Biomed mode.
Bolus
A single uninterrupted discrete volume
of fluid delivered over a discrete period
of time.
System Operating Manual
Plum A+ Infusion System
2- 5
TERM
DEFINITION
Cassette
A Hospira standard Plum Macro
Cassette that contains the actual
pumping chamber with inlet and outlet
valves. It also contains access ports to
diaphragms for proximal and distal line
pressure sensing and chambers for air
trapping and air quantity measurement.
Caution
Contains information which could
prevent hardware failure, irreversible
damage to equipment, or loss of data.
Channel
Distal Line output to the patient.
Cleared
Program
Same as Cleared Settings, but
restricted to the program delivery
settings for an individual line.
Cleared
Settings
Programmed delivery settings for both
lines and the general control
parameters are at their default values.
Clinical Care
Area (CCA)
An area of the hospital for which
authorized hospital staff has allowed
use of up to 99 specific drugs, plus No
Drug Selected. The clinician selects a
CCA after turning on the Infuser. The
hospital may create from one to twelve
CCA’s. The Clinician may ONLY select
a CCA when turning ON the infuser.
Concentration
For Dose Calculation based Line A or B
delivery programming of premixed
drugs, the concentration consists of
Drug Amount (in micrograms [mcg],
milligrams [mg], grams,
milliequivalents [mEq], or units [USP
Units]) and Diluent (Volume in
milliliters [mL]). Abbreviated on screen
displays as “Conc”.
Concurrent
Delivery
Simultaneous delivery of two fluids at
independent flow rates.
System Operating Manual
2- 6
2) Principles of Operation
TERM
DEFINITION
Concurrent
Mode
The Line B control selection mode that
allows either Line A or Line B (or both)
of the Mechanism to be programmed
for delivery that completes with KVO or
CR. Line A operation is unaffected by
Line B delivery.
Continue Rate
(CR)
An option used to provide fluid delivery
at the current fluid delivery rate when
the VTBI becomes zero.
Custom Drug
Library
Drug names available for use with the
Infuser in the selected CCA, and each
drug’s concentration, units of measure,
and dose limits, as determined by
authorized hospital staff. The Custom
Drug Library is based on hospitaldefined best practices. The Drug
Library is customized and downloaded
into the Infuser by authorized hospital
personnel using Hospira MedNet PCbased software.
Default Drug
Library (DDL)
A drug list of 99 drug names, default
units and default concentrations, plus
‘No Drug Selected.' Does not contain
Soft or Hard Limits. The DDL is a
subset of Plum A+ Version 11 drug list.
The infuser functions initially with the
DDL.
Deliver Together
A Biomed Delivery option setting,
which selects default of Piggyback or
Concurrent delivery mode.
Delivery Mode
The normal operational mode for the
Infuser, either Concurrent or
Piggyback, during which fluid delivery
may occur. (See Biomed for nondelivery mode.)
System Operating Manual
Plum A+ Infusion System
2- 7
TERM
DEFINITION
Delivery Rate
The delivery rate (as Volume/Time)
assigned by the operator or calculated
from other delivery parameters.
Device
The Plum A+ IV Infusion Device
(Infuser), not including the disposable
administration sets.
Diluent
(Volume)
The volume of fluid used with the
Diluent Unit (for example, 250 mL),
which dilutes the drug to be infused.
Distal
Downstream (output) from the Cassette
portion of the Administration Set.
Door
The lever-operated, bottom-hinged,
Cassette holder on the front of the
Mechanism.
Dose (Rate)
Delivery rate times drug concentration.
Dose
Calculation
Allows programming Dose Rates in
alternative units of measure. Dose
Calculation can be used in Simple
Delivery, Loading Dose, and Multistep.
Drug Amount
The mass or quantity of the drug
premixed with a Diluent to express the
Concentration for the Line being
programmed.
Drug List
See Hospital-Programmable
Downloadable Drug List with Rule Sets
(Custom Drug Library).
Duration
The time period used to deliver a VTBI
at an existing Delivery Rate or as set by
the operator.
Enteral
Delivery via an intestinal route.
System Operating Manual
2- 8
2) Principles of Operation
TERM
DEFINITION
Error
A condition resulting in an audible
warning and often an accompanying
message, such as an invalid key press,
resulting from an operator attempt to
make an input that is not valid for the
current operational context. Not a
Malfunction.
Filling Head
Height (FHH)
The gravity induced Proximal Line
pressure due to fluid height in source
container above the Distal Line output
level.
Flow Rate
The resulting rate of fluid flow. (See
Rate and Dose.)
Fluid Delivery
Begin
The time required, measured from the
initial start of a keypad press, for a digit
in the third decimal place of a scale
measuring grams to change when
pumping water, the delivery tube is
fluid filled, and the end of the delivery
tube is immersed.
Hard Limit
The dosing amount (upper and/or
lower amount) that when assigned to a
drug cannot be overridden. Defined by
the hospital for each drug in its Drug
Library. The hard limits for a particular
drug may vary across different CCAs.
Infuser
A Plum A+ device, not including the
disposable administration set.
Initialized
Position
The plunger is in the Plunger Park
Position, and each valve is in the Valve
Home Position.
Key
Any of the marked locations on the
front panels intended for user input via
a pressing action.
System Operating Manual
Plum A+ Infusion System
2- 9
TERM
DEFINITION
KVO
(Keep Vein Open) Internally selected
minimal delivery rate, the lesser of
1.0 mL/hr or actual Rate, intended to
provide sufficient fluid flow to prevent
clotting at the IV infusion site.
Line A
Inlet tubing on the top center of
Cassette when viewed after it has been
loaded in Mechanism Door.
Line B
Inlet connector on the top right of
Cassette when viewed after it has been
loaded in Mechanism Door.
Loading Dose
Allows programming of an initial
infusion rate for a specific volume,
followed automatically by a
maintenance rate from the same
container (for example, a fluid
challenge). If Dose Calc is used, the
Loading Dose and Maintenance Dose
are in the same unit of measure, over
the same period of time (mcg/min),
from the same container.
Macro Cassette
The Plum Cassette as part of an
Administration Set whose attainable
delivery performance is for general
purpose uses.
Malfunction
One of a number of conditions that
indicate a failure of the Infuser. These
conditions usually require a repair
action.
Mechanism
The provider of the physical activities
of: 1) valve control for Line selection
and inlet to or outlet from the Cassette;
2) Plunger extension and retraction for
changing fluid volume of the Cassette
pumping chamber.
System Operating Manual
2- 10
2) Principles of Operation
TERM
DEFINITION
MedNet
software
Networked application software used
to define and download the custom
drug library to the Infuser.
Multistep
Allows a sequential program to deliver
up to 10 steps; fluid volumes and
delivery rates may be programmed for
each step. The program may be
entered based on Rate and Volume or
Volume and Time. If Dose Calc is used,
the delivery steps are in the same unit
of measure, over the same period of
time, from the same container.
Note
A Note explains something new, gives
tips on performing an activity, or
provides a reminder of necessary
preparations.
Override
The clinician acknowledges an Alert,
confirms and proceeds with a program
containing a parameter that falls
outside the hospital-defined Soft
Limits.
Parenteral
Delivery via other than an intestinal
route, such as intravenous (IV)
injection.
Patient Weight
The Alternate Units Parameter whose
value entry is required with Dose rates
(quantity/time) having the third
parameter of weight, such as mcg/kg/
min.
Piggyback
Delivery
Infusion will stop Line A and infuse
Line B until VTBI completes.
System Operating Manual
Plum A+ Infusion System
2- 11
TERM
DEFINITION
Piggyback
Mode
The Line B control selection mode that
requires Line A delivery suspension
while Line B delivers and then its
resumption when Line B VTBI
completes. If Line A is not programmed
and started, Line B delivery just stops
when its VTBI completes. Line A
operation is delayed for duration of its
interruption by Line B.
Plunger Park
Position
The position of the pumping plunger
that allows the cassette to be
withdrawn from the Infuser without
restriction, with an opened Door.
POST
Power On Self Tests. Startup
initialization and test of critical
hardware modules and software
functions, to determine Infuser
readiness for its Intended Use.
Power On
When the power is first applied to the
Infuser processor. It occurs when
Infuser is in the off condition and the
AC power is applied or during battery
operation when the ON/OFF key is
pressed.
Pressure
The measured fluid pressure for
Proximal Line A, Proximal Line B, or
the Distal line when a fully primed
administration set is loaded into a
Mechanism with the Cassette Door
closed.
System Operating Manual
2- 12
2) Principles of Operation
TERM
DEFINITION
Programs
A Concentration-based extension to
basic Volume/Rate delivery for Dose
Rate applications. Softkey-selected
types are: 1) Standard Program for
single rate delivery; 2) Loading Dose
for up to two steps of delivery at
differing rates; 3) Multistep for up to
ten steps of delivery at differing rates.
Loading Dose and Multistep include
the basic Delivery Rate option.
Protocol
In the medical field, hospital-approved
procedures. For devices with an
electronic communications interface,
the format and content of messages
being exchanged.
Proximal
Upstream (input, as Line A and/or B)
with respect to the Cassette portion of
the Administration Set.
Rate
See Delivery Rate
Rounding
To round-off to the closest whole
number (for example, 25.5 would
round to 26, but 25.4 would round to
25).
Screen
That active portion of the LCD
assigned to a delivery or other user
interactive display operation.
Softkey
A front panel key whose function label
is on the bottom portion of the display
screen just above its location, so that
label may be changed to indicate
differing key functions within the
operational context of the defined
screens.
Standard
Programming
(see Basic Delivery)
System Operating Manual
Plum A+ Infusion System
2- 13
TERM
DEFINITION
Soft Limit
The dosing amount (upper and/or
lower amount) that when assigned to a
drug can be overridden based on
confirmation. Defined by the hospital
for each drug in its Drug Library. The
soft limits for a particular drug entry
may vary across CCAs.
Standby
A delivery program state that
resembles a delayed start for a line in
all respects, but status display of
STANDBY instead of DELAYED. A
press of the START key (and a Start
Softkey if necessary) will begin the
programmed delivery.
System
The Plum A+ Infuser system with its
associated accessories and
Administration Sets.
Tall-Man
Lettering
Tall-Man lettering uses upper-case
letters in combination with lower-case
letters to help clinicians differentiate
among sound-alike or look-alike drug
names. Certain Hospira Default Library
drug names are displayed in Tall-Man
lettering.
Therapy
A Concentration-based extension to
basic Volume/Rate delivery for Dose
Rate applications. Softkey-selected
types are: 1) Dose Calculation for
single rate delivery; 2) Loading Dose
for up to two steps of delivery at
differing rates; 3) Multistep for up to
ten steps of delivery at differing rates.
Loading Dose and Multistep include
the basic Delivery Rate option.
Truncate
To round-down to the last whole
number (for example, 103.7 would be
103).
System Operating Manual
2- 14
2) Principles of Operation
TERM
DEFINITION
Units
A Drug Amount (without a quantity of
mass referent) adopted as the United
States Pharmacopoeia (USP) standard
of measure for use in a Concentration.
VI
Volume Infused.
VTBI
Volume To Be Infused – The volume of
fluid or IV solution (remaining) for
delivery by a program or Therapy step
from a Line.
Warning
Audible indication at the defined
Warning sound level, often
accompanied by a brief message, to
advise operator that: 1. Input was
attempt to use a function in wrong
sequence, with wrong values, or at
wrong time (resulting in an Invalid Key
Warning); 2. Input was properly related
to a function (resulting in a Valid Key
Warning). (The Low Battery Warning is
an exception, using the Alarm
Indication sound level.)
Weight
The Alternate Units Parameter whose
value entry is required with Alternate
Units for Dose that include /kg/.
System Operating Manual
Plum A+ Infusion System
3)
3- 1
Equipment Description
Line B Flow
Indicator
Line A Flow
Indicator
Status
Region
Status Region
Working
Region
Working Region
Message
Region
Softkey
Label
Softkey
Selector
Start and
Stop Keys
Message Region
Back
Prime
A
Charging/
Line
Indicator
B
Options/
Vol Inf
LCD
Battery
Charge
Indicator
(2/3 full)
Numeric
Keys
(Up/Left)
Selection
Key
(Down/
Right)
Silence Key
ON/OFF
Key
Numeric Field
Clear Key
Decimal Point
Key
Basic Layout of Front Panel Display and
Keypad
System Operating Manual
3- 2
3) Equipment Description
3.1 Operating Keys
The [ON/OFF] key is used
to control the power of the
Plum A+.
NOTE: All deliveries must be
stopped in order to turn the
power off.
NOTE: To confirm proper
shutdown of pump, do not
unplug until “double beep” is
heard (approximately 5
seconds). If “double beep” is
not heard, the pump will turn
itself back ON sensing the AC
power was lost and revert to
battery back-up power.
The [START] key is used to
begin infusion. It brings up
the Confirmation screen. If
all information appears
correct, select  [Yes] to
start program.
The [STOP] key is used to
stop the current delivery
on one line; used in
conjunction with soft keys
to stop delivery on both
lines.
System Operating Manual
Plum A+ Infusion System
The [SILENCE] key is used
to silence an audible alarm
during actions to correct
its cause.
The [SELECT] key (or
)
is used to move the
highlighting cursor
between the programming
fields.
System Operating Manual
3- 3
3- 4
3) Equipment Description
The numeric keys are used
to enter values for any
highlighted field requiring
numeric data.
The [CLEAR] key will
cause a highlighted
numeric field to be cleared
in preparation for data
entry. It is also used to
clear the displayed dashes
(-- -- --) that occur when
entering values beyond
the pre-programmed hard
limits. It WILL NOT clear
the entire program.
The [DECIMAL POINT] key
is used to manually enter
numbers other than whole
numbers (that is, 1.2 mL).
The Softkeys are located
at the bottom of the main
display and serve a variety
of functions. What each
key does is indicated by
the text in the display
above the actual softkey.
Standby
Enter
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
3.2 Indicators
The Charge/Line Indicator
is illuminated to indicate
the battery is currently
charging.
NOTE: If the device is plugged
into AC power, with a battery
installed, and the Charge
Indicator is not illuminated,
contact technical support.
The Fluid Drop Symbol,
when flashing, indicates
an active infusion on Line
A and/or Line B.
System Operating Manual
3- 5
3- 6
3) Equipment Description
3.3 Display Symbols
The Battery Capacity
Symbol (located on the
right side of message
region on display)
indicates relative charge
with the number of white
boxes from left to right.
This example indicates the
battery is about two-thirds
full.
The Cautionary Symbol is
displayed to instruct the
user to read the drug
package insert as the
pump is being operated
without rule sets (soft or
hard limits).
!
The Soft Limit Override
Symbol indicates the
programmed soft limits
upper (up arrow) or lower
(down arrow) have been
overridden.
NOTE: The pump will display the rule set icon from the
first step in a situation where a 2-step process is
completed and the pump is stopped after going to KVO.
System Operating Manual
Plum A+ Infusion System
3- 7
3.4 Rear Case Controls
The Audio Level Rotary
Knob is located on the
back of the pump. Rotate
the knob to achieve the
desired alarm volume
level.
The Toggle Switch, located
below the audio level
control, activates the
lockout function when the
lever is placed in the “up”
position, disabling all front
panel keys except [STOP].
The Password Protected
Keypad Lock may also be
used. It both locks and
unlocks the keypad by
pressing the decimal key,
followed by 9, 6, and 3.
NOTE: Pressing of a key while lockout is active results in the
display of the lockout enabled message. This action is
recommended to confirm each lockout activation.
NOTE: If the lockout switch is put in the “Locked” position
while the pump is off, the [ON/OFF] key allows the unit to turn
on.
System Operating Manual
3- 8
3) Equipment Description
The connector located
below the lockout switch
is the Nurse Call Relay
Connector, for providing
remote notification of a
nurse call event.
The RS-232 Dataport is
used to interface with a
host computer.
NOTE: Do not connect to
Dataport while infusing
System Operating Manual
Plum A+ Infusion System
3- 9
3.5 Administration Sets
The Plum A+ is compatible with a wide range of LifeCare
Plum series administration sets. Become familiar with the
set components before preparing the administration set.
Convertible Piercing Pin
with Drip Chamber
Slide Clamp
Primary Line
Cassette
Patient Line
CAIR (roller) Clamp
Administration Set
Primary Line
Secondary
Inlet Port
(Capped)
Finger Grip
Flow Regulator
Patient Line
Pumping Chamber
Air Trap
Cassette
System Operating Manual
3- 10
3) Equipment Description
PREPARING THE ADMINISTRATION SET
NOTE: For detailed instructions, see administration set
packaging.
WARNING
ARRANGE TUBING, CORDS, AND CABLES TO
MINIMIZE THE RISK OF PATIENT STRANGULATION
OR ENTANGLEMENT.
Use the aseptic technique to prepare the administration set for
priming, then proceed as follows:
1) Make sure flow regulator is closed.
2)
Insert piercing pin into container outlet
with a twisting motion.
3) Fill drip chamber to about 1/2 full or to
the score mark. Do not completely fill.
NOTE: To avoid getting Distal Air Alarms,
confirm the fluid bag is positioned higher
than the pump. This should be set up prior
to priming the cassette.
System Operating Manual
Plum A+ Infusion System
3- 11
PRIMING THE ADMINISTRATION SET
1) Invert the cassette.
2) Turn the flow regulator counterclockwise until a drop of fluid is seen in
the pumping chamber.
3) Turn the cassette upright, then prime
the remainder of the administration set.
4) Push in the flow regulator to close.
Confirm there is no flow.
LOADING THE CASSETTE
To load the primed cassette into the plum A+, proceed as follows.
1) Open the cassette door by lifting up the
handle.
System Operating Manual
3- 12
2)
3) Equipment Description
Insert cassette into door guides. Close
the cassette door. Confirm there is no
flow and no kinks appear in tubing.
NOTE: If flow is observed, close the tubing
clamps and replace the administration set.
NOTE: The administration set should be
changed per CDC guidelines or healthcare
provider policy. Discard after use.
PREPARING THE SECONDARY LINE
CAUTION:
CONSULT THE DRUG LABELING TO CONFIRM
DRUG COMPATIBILITY, CONCENTRATION, DELIVERY RATES,
AND VOLUMES ARE ALL SUITABLE FOR CONCURRENT
DELIVERY OR PIGGYBACK DELIVERY (SECONDARY FOLLOWED
AUTOMATICALLY BY PRIMARY) MODES.
The Plum A+ features concurrent or piggyback delivery modes
when therapy requires administering more than one fluid.
In addition to standard containers, the Plum A+ can use syringes
on the secondary port. The secondary line can be prepared
without removing or repriming the cassette.
Before preparing the secondary line, observe the following
guidelines:
•
Review the backpriming function.
•
Attach the secondary container using an 18or 19- gauge, 31 mm (or shorter) needle, if the
cassette secondary inlet port has a piercing
reseal.
•
Syringes must be larger than 3 cc. Use
syringe adapter (List 11986-48) when using
syringes smaller than 10 cc. Some 10 cc
syringes may require use of a syringe
adapter. Syringes larger than 10 cc may be
attached directly to the secondary port of the
cassette. Use of a syringe adapter may
System Operating Manual
Plum A+ Infusion System
decrease the occurrence of proximal
occlusion alarms.
•
When using a syringe adapter, retract the
plunger to draw approximately 1 mL of fluid
into the syringe to clear air from the adapter
filter.
To prepare the secondary line, use aseptic technique and
proceed as follows:
1)
With cassette door closed: Loosen and
remove white cap, then discard. Add
secondary tubing or syringe.
2
Open all proximal clamps before
pressing [START].
3) Set up per operating instructions. (See
Sections 4 - 6 of this manual.)
4) Syringe: Secure the container to the
cassette door using the optional
container support arm (List 12095-03).
System Operating Manual
3- 13
3- 14
3) Equipment Description
3.6 Discontinuing Electronic Flow Control
and Setting Gravity Flow
If electronic flow needs to be stopped, the precision flow regulator
on the cassette can be used to manually set and maintain fluid
flow in a gravity mode (see the following graphics).
CAUTION:
BEFORE OPENING DOOR, CLOSE CLAMP ON PRIMARY
OR SECONDARY SET OR REMOVE SECONDARY CONTAINER FROM
SECONDARY PORT TO PREVENT MIXING OF PRIMARY AND
SECONDARY FLUIDS.
WARNING
TO PREVENT UNRESTRICTED FLOW, CLOSE ALL SLIDE OR
CAIR CLAMPS PRIOR TO OPENING THE CASSETTE DOOR.
1 PRESS STOP
STOP
2 CLOSE ALL SLIDE OR CAIR
(ROLLER) CLAMPS
3 OPEN DOOR & REMOVE CASSETTE
TO CLOSE
SLIDE CLAMP
CLOSED
POSITION
NOTE: FLOW REGULATOR CLOSES
AUTOMATICALLY WHEN DOOR IS OPENED
TO PREVENT ACCIDENTAL FREE FLOW
Roller
Roller
TO CLOSE
CAIR (ROLLER)
CLAMP
CLOSED
POSITION
4 SET GRAVITY RATE BY TURNING FLOW
REGULATOR COUNTER-CLOCKWISE
NOTE: IF DOOR OPEN ALARM OCCURS,
TURN PUMP OFF
NOTE: CASSETTE SHOULD BE IN UPRIGHT
POSITION AND CLAMPS SHOULD BE OPEN
System Operating Manual
Plum A+ Infusion System
3- 15
3.7 Discontinuing Fluid Administration
1 PRESS STOP
STOP
2 CLOSE ALL SLIDE OR CAIR
(ROLLER) CLAMPS
3 OPEN DOOR, REMOVE CASSETTE
TO CLOSE
SLIDE CLAMP
CLOSED
POSITION
Roller
Roller
TO CLOSE
CAIR (ROLLER)
CLAMP
CLOSED
POSITION
4 CLOSE DOOR
5
System Operating Manual
DISCARD SET AND FLUID
CONTAINER PER HOSPITAL
PROCEDURE
3- 16
3) Equipment Description
NOTES
System Operating Manual
Plum A+ Infusion System
4)
4- 1
Basic Operation
4.1 Getting Started
UNPACKING
CAUTION: P RODUCT DAMAGE MAY OCCUR UNLESS
PROPER CARE IS EXERCISED DURING UNPACKING AND
INSTALLATION. DO NOT USE THE PLUM A+ IF IT APPEARS
DAMAGED IN ANY WAY. THE BATTERY MAY NOT BE CHARGED
UPON RECEIPT.
Inspect the Plum A+ packaging for possible shipping damage. If
damage is found, contact the delivery company immediately.
Use care when unpacking the pump. Retain the packing slip and
save all packing material in case the pump is damaged or fails
the pump self-test and has to be returned to Hospira.
Inspect thoroughly for damage.
CAUTION: IF THE PLUM A+ APPEARS TO BE DAMAGED,
CONTACT HOSPIRA.
To set up, connect the AC (mains) cord to a properly grounded
receptacle, unless temporary battery operation is desired.
NOTE: Use AC (mains) power whenever possible. Store
the pump connected to AC (mains) to confirm a fully
charged battery for emergencies.
NOTE: If the quality of the earth grounding source is in
doubt, use battery power.
System Operating Manual
4- 2
4) Basic Operation
CAUTION: T HE P LUM A+ SYSTEM IS DESIGNED TO
O P E R A T E N O R M A L L Y I N T H E P R E S E N CE O F M O S T
ENCOUNTERED ELECTROMAGNETIC INTERFERENCE (EMI)
CONDITIONS . I N THE EVENT OF EXTREME LEVELS OF
INTERFERENCE , SUCH AS ENCOUNTERED NEXT TO AN
ELECTROSURGICAL GENERATOR, CELLULAR TELEPHONES, OR
2-WAY RADIOS, IT IS POSSIBLE THAT THE NORMAL OPERATION
OF A SENSOR OR MICROCOMPUTER MIGHT BE DISRUPTED.
OPERATION OF THE PUMP UNDER THESE CONDITIONS SHOULD
BE AVOIDED.
TANDEM CARRIER INSTRUCTIONS
The Plum A+ may be safely and conveniently mounted on an IV
stand or on a tandem carrier mounted on an IV stand.
Always mount the tandem carrier (List#
12270-01) to the pole before attaching
the pump(s) to the tandem carrier.
Make sure tandem carrier clamp is
attached firmly to the pole.
Make sure pumps are firmly attached
to the tandem carrier.
This section details the Plum A+ instrument setup procedures.
SYSTEM SELF-TESTS
The pump performs a suite of System Self-Tests when power is
applied to confirm readiness for use.
Failure during the Self-Tests is reported as a Malfunction
Condition.
CAUTION: DO NOT PLACE THE PLUM A+ IN SERVICE IF IT
SYSTEM SELF-TESTS.
FAILS THE
System Operating Manual
Plum A+ Infusion System
4- 3
Connect the AC power (mains) cord to an AC power receptacle,
then confirm that the Charging/Line indicator illuminates (above
the [ON/OFF] key on the front panel).
A systematic self-testing of the processing, delivery, and safety
systems is performed whenever the Plum A+ is turned on, to
verify readiness for operation.
NOTE: If the quality of the earth grounding source is in doubt,
use battery power.
Press the [ON/OFF] key to turn the power on. Check the screen
display and listen for a beep to indicate that the audio is working.
Wait for the self-tests to complete. If successful, put a fully primed
macro cassette into the cassette door and close the door. See
Loading the Cassette in Section 3 for details of correct procedure.
When the Charging/Line indicator is off and the battery symbol on
the display is flashing, this indicates that the Plum A+ is operating
on low battery power and should be recharged.
CAUTION: DO NOT OPERATE THE PLUM A+ ON PATIENTS
WITH THE BATTERY REMOVED . U SE OF A PROPERLY
MAINTAINED AND CHARGED BATTERY HELPS CONFIRM
PROPER OPERATION.
To confirm that the battery is fully charged, connect the Plum A+
to AC (mains) power for a minimum of six hours while in the OFF
mode.
If an alarm occurs during the power on self-test, identify the alarm
message, then take corrective action, see Section 7, Alarms and
Troubleshooting.
Turn pump OFF, then back ON. If the self-test alarm recurs,
remove the pump from service and contact the local Hospira
representative.
System Operating Manual
4- 4
4) Basic Operation
DATA RETENTION
Delivery program settings and programming option selections are
retained in non-volatile memory. If the Plum A+ has been turned
off for longer than four hours, all delivery settings are cleared and
programming option selections are restored to their default
selections for next use.
4.2 Power On
1)
Press
to turn on
the Plum A+ and you will
see the System Self-Tests
screen.
HOSPIRA Plum A+
Release XX.X- xx/xx/xx
2005
System Self Test
In Progress
CAUTION: THE PUMP MUST BE
INITIALLY STARTED ON AC POWER,
OTHERWISE NETWORKING MAY NOT
OPERATE PROPERLY.
After self-testing
successfully completes,
the display will proceed to
the next screen.
**SCREENS SHOWN IN THIS
MANUAL ARE EXAMPLES ONLY AND
DON’T NECESSARILY REFLECT
CURRENT CLINICAL PRACTICE**
Programming the pump may begin during the
cassette check phase of the start-up testing.
NOTE: If battery is missing or defective, a “Battery not
installed” message with a “Continue without battery” prompt
will appear (AC power only).
CAUTION: DO NOT OPERATE THE PLUM A+ ON PATIENTS
WITH THE BATTERY REMOVED . U SE OF A PROPERLY
MAINTAINED AND CHARGED BATTERY HELPS CONFIRM
PROPER OPERATION.
System Operating Manual
Plum A+ Infusion System
2)
4- 5
To set up the Plum A+,
insert selected PlumSet
and close cassette holder
door lever.
SETUP
Insert PLUM Set
Close Lever
NOTE: If cassette is already
inserted, this screen is skipped.
If Infuser ID Entry screen appears,
consult your hospital’s biomed
personnel.
The Area Selection screen
will appear if your system
has been programmed with
the Hospira MedNet
accessory. Use
to
choose. If only one CCA
has been entered, it
becomes the default and
this screen is skipped.
Area Selection
Any Hospital, USA
MM/DD/YY XXYYZZ- 123456
ICU
MedSurg
OR
Cardio
Urology
Psych
Renal
Neo ICU
OB/GYN
Oncol
Ad ICU
ER
Select, then Enter
Enter
If not using MedNet, the display will go straight
to the “Clear Settings ?” option.
Example of Clear Settings
Screen
3)
The on-screen message
“Clear Settings?” may
appear. Select  [Yes] to
clear all settings.
A
SETUP
Clear Settings?
Yes clears ALL settings
Yes
System Operating Manual
B
No
4- 6
4) Basic Operation
Clear ALL settings when changing patients or
multiple programming parameters.
NOTE: This clears all delivery parameters, such as Rate and
VTBI on both lines, as well as setting items, such as the KVO
and Nurse Callback options, to their default values.
NOTE: If no settings currently exist or all settings are zero,
this screen will be bypassed.
4.3 Simple Delivery
Example of MedNet Main
Delivery Screen (with
cleared settings). The
selected area is displayed
at the bottom.
A STOPPED STOPPED B
Rate
mL/hr
0
0
Vol Inf
mL
0
MedSurg
**SCREENS SHOWN IN THIS
MANUAL ARE EXAMPLES ONLY AND
DON’T NECESSARILY REFLECT
CURRENT CLINICAL PRACTICE**
0
Back
Prime
A
B
Options/
Vol Inf
NOTE: For clarity, whole number font sizes will appear larger
than partial number font sizes (numbers on the right-side of
the decimal).
1)
To program delivery rate, select  [A].
System Operating Manual
Plum A+ Infusion System
2)
3)
To enter delivery rate, use
numeric keypad.
Use
to move down to
the VTBI field.
4- 7
A
PROGRAM
MedSurg
Rate
0
mL/hr
VTBI
0
mL
Duration
00:00
hr : min
Enter Value using keypad
Program
Options
4)
To enter VTBI amount,
use keypad.
NOTE: While the VTBI is being
entered, the duration is
automatically computed. If the
computed value is greater than
99:59, dashes (- -) appear in place
of hours.
5)
A
Therapy
Cancel/
Back
PROGRAM
MedSurg
Rate
5.5
VTBI
0
Duration
00:00
mL/hr
mL
hr : min
Enter value using keypad
Program
Options
Therapy
Cancel/
Back
Use
to move down to
the Duration field.
If the auto-calculated Duration is acceptable,
skip to Step 9.
6)
Use keypad to change the
hours part of the duration
if desired.
A
PROGRAM
MedSurg
Rate
5.5
mL/hr
VTBI
0.5
mL
Duration
00:05
hr : min
Enter value using keypad
Program
Options
System Operating Manual
Therapy
Cancel/
Back
4- 8
4) Basic Operation
NOTE: When all parameters are displayed, changing any
one parameter will result in other parameters automatically
being computed. To understand the Automatic Calculation
feature, see Section 6.7, Examples of Automatic Calculation.
7)
Use
to change from hours to minutes.
NOTE: The maximum hours allowed is 99 and the maximum
minutes is 59.
8)
Use keypad to change minutes.
CAUTION:
V ERIFY RATE,
BEFORE PRESSING [START].
9)
Press
VTBI, AND DURATION
PROGRAM
A
.
MedSurg
Delivery will be:
Program Confirmation
screen will appear. If
correct, press  [Yes] to
begin infusion.
No Drug Selected
5.5 mL/hr
0.5 mL
Drug
Rate
VTBI
!
Confirm Program?
Yes
Example of Main Delivery
Screen just after being
programmed and started.
No
A PUMPING STOPPED B
5.5
Rate
mL/hr
0
0.1
Vol Inf
mL
0
!
NOTE: The Line A Fluid Flow
Indicator also will flash to indicate
pumping.
MedSurg
A
B
Options/
Vol Inf
System Operating Manual
Plum A+ Infusion System
4- 9
4.4 Titration
1)
Select Line  [A] (or [B])
at the Main Delivery
Screen.
A PUMPING PUMPING B
25
Rate
mL/hr
50
41
Vol Inf
mL
20
!
!
MedSurg
A
2)
Enter the desired Rate
using the keypad.
A
V ERIFY RATE,
BEFORE PRESSING [START].
3)
Press
.
PROGRAM
MedSurg
NOTE: When Rate is changed, the
duration is automatically
recomputed using the current
VTBI. To understand the Automatic
Calculation feature, see Section
6.7, Examples of Automatic
Calculation.
CAUTION:
Options/
Vol Inf
B
Rate
15
mL/hr
VTBI
50
mL
Duration
03:20
hr : min
Enter Value using keypad
Program
Options
Therapy
Cancel/
Back
VTBI, AND DURATION
A
PROGRAM
MedSurg
Delivery will be:
Program Confirmation
screen will appear. If
correct, press  [Yes] to
begin infusion.
Drug
Rate
VTBI
!
Confirm Program?
Yes
System Operating Manual
No Drug Selected
15 mL/hr
50 mL
No
4- 10
4) Basic Operation
NOTE: During Titration, pump continues to deliver at
previous parameters until new program is confirmed.
Example of Main Delivery
Screen after being titrated.
NOTE: Volume Infused is an
incrementing value which is
cleared in  [Options/Vol Inf].
A PUMPING PUMPING B
15
Rate
mL/hr
50
41.6
Vol Inf
mL
20
!
MedSurg
The following 3 screens
are examples of changed
values.
Example of changed rate.
!
A
A
B
Options/
Vol Inf
PROGRAM
MedSurg
4)
5)
From the Main Delivery
Screen, select  [A].
Use keypad to change the
Rate value.
Rate
15
mL/hr
VTBI
50
mL
Duration
03:20
hr : min
Enter Value using keypad
Program
Options
Therapy
Cancel/
Back
NOTE: The display time is only
accurate to ± one minute. As
shown in this example, the delivery
shows 3 hours and 20 minutes (not
3 minutes and 20 seconds).
6) Press
.
Program Confirmation screen will appear. If
correct, press  [Yes] to begin infusion.
NOTE: [START] accepts the change. Delivery is changed to
the new Rate and Duration and display returns to Main
Delivery Screen.
System Operating Manual
Plum A+ Infusion System
Example of Changed VTBI
value.
7)
Use
to highlight the
VTBI field.
4- 11
A
PROGRAM
MedSurg
Rate
15
VTBI
100
Duration
06:40
mL/hr
mL
hr : min
Enter Value using keypad
8)
Use the keypad to change
the VTBI value.
Program
Options
Therapy
Cancel/
Back
NOTE: When the VTBI is changed, the Duration is
recomputed with respect to the current Rate. To understand
the Automatic Calculation feature, see Section 6.7, Examples
of Automatic Calculation.
9) Press
.
Program Confirmation screen will appear. If
correct, press  [Yes] to begin infusion.
NOTE: [START] accepts the change. Delivery is changed to
the new VTBI and Duration and the display brings up the
Confirmation screen before returning to the Main Delivery
Screen.
System Operating Manual
4- 12
4) Basic Operation
Example of changed
Duration field.
A
PROGRAM
MedSurg
10) Use
to highlight the
Duration field, then use
the keypad to change its
value.
Rate
150
mL/hr
VTBI
100
mL
Duration
00:40
hr : min
Enter Value using keypad
Program
Options
Therapy
Cancel/
Back
NOTE: When Duration is changed,
Rate is automatically recomputed
using the current VTBI value. To
understand the Automatic
Calculation feature, see Section
6.7, Examples of Automatic
Calculation.
CAUTION:
V ERIFY RATE,
BEFORE PRESSING [START].
11) Press
VTBI, AND DURATION
.
Program Confirmation screen will appear. If
correct, press  [Yes] to begin infusion.
NOTE: [START] accepts the change. Delivery is changed to
the new Duration and Rate and the display brings up the
Confirmation screen before returning to the Main Delivery
Screen.
System Operating Manual
Plum A+ Infusion System
4- 13
4.5 Piggyback Delivery
PIGGYBACK DELIVERY Infusion will stop Line A
and infuse Line B until
VTBI completes. Line A will
automatically restart.
A PUMPING STOPPED B
5.5
Rate
mL/hr
5
20
Vol Inf
mL
0
!
!
MedSurg
1)
With Line A pumping, to
program a Piggyback
delivery, select  [B].
The Delivery Mode field is
highlighted.
A
2)
If field reads
“Concurrent”, select
[Change Mode] to switch
to “Piggyback”.
System Operating Manual
Options/
Vol Inf
B
PROGRAM
MedSurg
Mode
NOTE: If an entry was previously
programmed, Rate is highlighted. If
no previous entries, Mode is
highlighted.
B
Rate
VTBI
Duration
Piggyback
0
0
00:00
mL/hr
mL
hr : min
Change using Change Mode
Program Change
Therapy
Options
Mode
Cancel/
Back
4- 14
3)
4) Basic Operation
Select
to highlight the
Rate field.
Mode
Piggyback
Rate
4)
To enter delivery rate, use
numeric keypad.
B
PROGRAM
MedSurg
VTBI
Duration
200
0
00:00
mL/hr
mL
hr : min
Enter value using keypad
Program
Options
5)
Use
to move down to
the VTBI field.
6)
To enter VTBI amount,
use keypad.
Therapy
B
PROGRAM
MedSurg
Mode
NOTE: While the VTBI is being
entered, the duration is
automatically computed. If the
computed value is greater than
99:59, dashes (- -) appear in place
of hours. To understand the
Automatic Calculation feature, see
Section 6.7, Examples of
Automatic Calculation.
Cancel/
Back
Rate
VTBI
Duration
Piggyback
200
100
00:30
mL/hr
mL
hr : min
Enter value using keypad
Program
Options
Therapy
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
7)
4- 15
B
PROGRAM
Use
to move down to
the Duration field.
MedSurg
Mode
Piggyback
133
100
00:45
Rate
(Optional) Use keypad to
change duration.
VTBI
Duration
mL/hr
mL
hr : min
Enter value using keypad
When all parameters are
displayed, changing any
one parameter will result in
other parameters
automatically being
computed.
CAUTION:
V ERIFY RATE,
BEFORE PRESSING [START].
8) Press
Program
Options
Therapy
Cancel/
Back
VTBI, AND DURATION
.
Program Confirmation screen will appear. If
correct, press  [Yes] to begin infusion.
NOTE: If Line A has a Delay Start remaining, a message will
appear warning of a possible non-delivery (see Section 6.3).
Example of Main Delivery
Screen just after being
programmed and started.
A DELAYED PUMPING B
5.5
Rate
mL/hr
133
20
Vol Inf
mL
0.1
!
!
MedSurg
A
System Operating Manual
B
Options/
Vol Inf
4- 16
4) Basic Operation
4.6 Concurrent Delivery
CONCURRENT DELIVERY Simultaneous delivery of two
fluids at independent flow rates.
CAUTION: CONSULT DRUG
LABELING TO CONFIRM DRUG
COMPATIBILITY , CONCENTRATION ,
DELIVERY RATES, AND VOLUME ARE
ALL SUITABLE FOR CONCURRENT AND
PIGGYBACK DELIVERY MODES. SEE
SECTION 1 FOR INFORMATION ON
CONCURRENT FLOW, SEE SECTION 9
FOR DELIVERY RATE RANGES.
A PUMPING STOPPED B
5.5
Rate
mL/hr
0
0.1
Vol Inf
mL
0
!
MedSurg
A
B
Options/
Vol Inf
NOTE: In concurrent mode with certain alarm conditions, one
line may stop while the other line may continue to deliver.
1)
With pumping started on line A, to program a
Concurrent delivery rate, select  [B].
The Delivery Mode field is
highlighted.
Mode
NOTE: If an entry was previously
programmed, Rate is highlighted. If
no previous entries, Mode is
highlighted.
If field reads “Piggyback”,
select [Change Mode] to
switch to “Concurrent”.
B
PROGRAM
MedSurg
Rate
VTBI
Duration
Piggyback
0
0
00:00
mL/hr
mL
hr : min
Change using Change Mode
Program Change
Therapy
Options
Mode
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
Verify change to
“Concurrent” mode.
4- 17
B
PROGRAM
MedSurg
Mode Concurrent
Rate
2)
Use
field.
to highlight Rate
VTBI
Duration
0
0
00:00
mL/hr
mL
hr : min
Change using Change Mode
Program Change
Therapy
Options
Mode
3)
To enter delivery rate, use
numeric keypad.
Cancel/
Back
B
PROGRAM
MedSurg
Mode Concurrent
NOTE: When Rate for Line A plus
Rate for Line B is greater than valid
rate ranges, a “Concurrency
violation” message will explain why
second line did not start. See
Section 9 for valid delivery rate
ranges.
Rate
VTBI
Duration
10
0
00:00
mL/hr
mL
hr : min
Enter value using keypad
Program
Options
Therapy
Cancel/
Back
NOTE: “Concurrency violation” may not be displayed if unit is
displaying “VTBI Complete”. The device will not start and an
invalid keypress sound will occur when [START] is pressed.
4)
Use
to move down to the VTBI field.
System Operating Manual
4- 18
5)
4) Basic Operation
To enter VTBI amount,
use keypad.
B
PROGRAM
MedSurg
Mode Concurrent
NOTE: While the VTBI is being
entered, the Duration is
automatically computed. If the
computed value is greater than
99:59, dashes (- -) appear in place
of hours. To understand the
Automatic Calculation feature, see
Section 6.7, Examples of
Automatic Calculation.
6)
Use
10
100
10:00
Rate
VTBI
Duration
mL/hr
mL
hr : min
Enter value using keypad
Program
Options
Therapy
Cancel/
Back
to move down to the Duration field.
(Optional) Enter values for desired hours and
minutes.
NOTE: When Duration is entered, Rate is automatically
computed.
V ERIFY RATE,
BEFORE PRESSING [START].
CAUTION:
7)
Press
VTBI, AND DURATION
.
Program Confirmation screen will appear. If
correct, press  [Yes] to begin infusion.
Example of a concurrent
delivery.
A PUMPING PUMPING B
5.5
Rate
mL/hr
10
20.4
Vol Inf
mL
1
!
!
MedSurg
A
B
Options/
Vol Inf
System Operating Manual
Plum A+ Infusion System
4- 19
4.7 Stop and Start with Only 1 Line
Pumping
1)
Press
at the Main
Delivery Screen.
A PUMPING STOPPED B
100
Rate
mL/hr
0
8.5
Vol Inf
mL
0
!
NOTE: If [A] (or  [B]) is
selected prior to pressing [STOP],
the display will return to the
programming screen. Select
 [Cancel/Back] to return to the
Main Delivery screen.
Example of stopped
delivery.
2)
To resume infusion, press
MedSurg
Back
Prime
Options/
Vol Inf
A STOPPED STOPPED B
100
Rate
mL/hr
0
8.5
Vol Inf
mL
0
!
.
MedSurg
Or, to discontinue infusion,
press
B
A
Back
Prime
A
.
3)
Clamp secondary tubing
if connected.
4)
Close all slide or CAIR
clamps.
5)
Open cassette door,
remove set and close
door.
System Operating Manual
To close CAIR
(roller) clamp
B
Options/
Vol Inf
4- 20
4) Basic Operation
4.8 Stop and Start with Both Lines
Pumping
1)
Press
at the Main
Delivery Screen.
A PUMPING PUMPING B
25
Rate
mL/hr
50
3
Vol Inf
mL
20.4
!
!
MedSurg
B
A
2)
Select  [Stop A],  [Stop
B], or  [Stop All].
NOTE: If  [A] (or  [B]) is
selected prior to [STOP], the
display will show the programming
screen. Select  [Cancel/Back] to
return to the Main Delivery screen.
Options/
Vol Inf
A PUMPING PUMPING B
25
Rate
mL/hr
50
3
Vol Inf
mL
20.4
!
!
MedSurg
Choose line(s) to stop:
Stop
All
Stop
A
Stop
B
Cancel
System Operating Manual
Plum A+ Infusion System
4- 21
Example of stopped
infusion.
A STOPPED STOPPED B
NOTE: This is an example using
 [Stop All].
25
Rate
mL/hr
50
3
Vol Inf
mL
20.4
!
!
MedSurg
Back
Prime
A
B
Options/
Vol Inf
CAUTION: VERIFY RATE, VTBI,
DURATION BEFORE PRESSING
[START].
AND
3)
To resume infusion,
press
A STOPPED STOPPED B
.
25
Rate
mL/hr
50
3
Vol Inf
mL
20.4
!
4)
Select [Start A],
 [Start B], or  [Start All].
Or, to discontinue
infusion, press
.
5)
Clamp secondary tubing
if connected.
6)
Close all slide or CAIR
clamps.
7)
Open cassette door,
remove set and close
door.
System Operating Manual
!
MedSurg
Choose line(s) to start:
Start
All
Start
A
To close CAIR
(roller) clamp
Start
B
Cancel
4- 22
4) Basic Operation
4.9 Backpriming
BACKPRIMING - Removal of air
or fluid from the proximal line
and cassette airtrap.
1)
To initiate a backprime,
select  [Back Prime].
NOTE: Backpriming is available
only when all delivery is stopped.
Secondary container is necessary
to receive the air.
2)
A STOPPED STOPPED B
Select and hold
 [Back Prime] until fluid
pumped from line A to
line B has expelled the air
from cassette air trap into
Secondary container.
5.5
Rate
mL/hr
0
8.9
Vol Inf
mL
0
Back
Prime
A
A
B
Options/
Vol Inf
B
BACKPRIMING
5.5
Rate
mL/hr
0
8.9
Vol Inf
mL
0
Release Backprime to Stop
NOTE: Fluid flow is at maximum
rate possible.
3)
Back
Prime
A
B
Options/
Vol Inf
Upon release of  [Back Prime], the cassette
test is performed to confirm readiness for
pumping. Pressing
programmed delivery.
will resume
System Operating Manual
Plum A+ Infusion System
4- 23
4.10 Clearing Settings
1)
Press
at the Main
Delivery Screen.
A PUMPING STOPPED B
5.5
Rate
mL/hr
0
0.1
Vol Inf
mL
0
!
Clear ALL settings when
changing patients or
multiple programming
parameters.
2)
Select Line  [A] (or [B] if
active) from the stopped
Main Delivery Screen.
NOTE: If Line A or B is
programmed with a Therapy (that
is, Dose Calculation), Rate, VTBI
and Duration will not display
values. The values to be cleared
may be viewed in applicable
programming screen under 
[Therapy].
3)
Select  [Yes].
Clear ALL settings when
changing patients or
multiple programming
parameters.
MedSurg
Options/
Vol Inf
A STOPPED STOPPED B
5.5
Rate
mL/hr
0
8.9
Vol Inf
mL
0
Back
Prime
A
A
B
Options/
Vol Inf
PROGRAM
Clear Line A Settings?
Yes
System Operating Manual
B
A
No
4- 24
4) Basic Operation
Example screen of
“Cleared Settings”.
4)
A
PROGRAM
MedSurg
Select  [Cancel/Back] to
return to the Main
Delivery screen or
program new settings.
Rate
0
mL/hr
VTBI
0
mL
Duration
00:00
hr : min
Enter Value using keypad
Program
Options
Therapy
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
5)
Dose
Calculation
Loading
Dose
Multistep
5- 1
Therapies
(Standard Program)
Allows programming Dose Rates in
alternative units of measure. Dose
Calculation can be used in Simple Delivery,
Loading Dose, and Multistep.
Allows programming of an initial infusion
rate for a specific volume, followed
automatically by a maintenance rate from
the same container (for example, a fluid
challenge).
If Dose Calc is used, the Loading Dose and
Maintenance Dose are in the same unit of
measure, over the same period of time
(mcg/min), from the same container.
Allows a sequential program to deliver up to
10 steps; fluid volumes and delivery rates
may be programmed for each step. The
program may be entered based on Rate and
Volume or Volume and Time. If Dose Calc is
used, the delivery steps are in the same unit
of measure, over the same period of time,
from the same container.
NOTE: During Therapy programming, user must identify
desired drug with softkey drug list prior to setting program
parameters.
Use drug manufacturer recommendations for IV
administration when using the Plum A+ infusion pump.
System Operating Manual
5- 2
5) Therapies
5.1 Dose Calc (mcg/kg/min on A)
DOSE CALCULATION - Allows programming
Dose Rates in alternative units of measure.
Dose Calculation can be used in Simple
Delivery, Loading Dose, and Multistep.
Clear ALL settings when changing patients or
multiple programming parameters.
The Area Selection screen
will appear if your system
has been programmed with
the MedNet accessory.
Use
to select and bring
you to the Main Delivery
Screen.
1)
Select  [A] at the Main
Delivery Screen.
Area Selection
Any Hospital, USA
MM/DD/YY XXYYZZ- 123456
ICU
MedSurg
OR
Cardio
Urology
Psych
Select, then Enter
Enter
A STOPPED STOPPED B
**SCREENS SHOWN IN THIS
MANUAL ARE EXAMPLES ONLY AND
DON’T NECESSARILY REFLECT
CURRENT CLINICAL PRACTICE**
Renal
Neo ICU
OB/GYN
Oncol
Ad ICU
ER
0
Rate
mL/hr
0
0
Vol Inf
mL
0
MedSurg
Back
Prime
A
B
Options/
Vol Inf
System Operating Manual
Plum A+ Infusion System
The Line A Programming
screen appears.
2)
5- 3
A
PROGRAM
MedSurg
Select  [Therapy] for
Dose Calculation
programming.
Rate
0
mL/hr
VTBI
0
mL
00:00
Duration
hr : min
Enter Value using keypad
Program
Options
The Drug List Screen
appears, in mainly
alphabetical order.
NOTE: Default entry is “No Drug
Selected”.
A
Therapy
Cancel/
Back
MedSurg
No Drug Selected
25 grams/500 mL
Albumin 5%
2.6 mg/50 mL
Aldesleukin
10 mg/250 mL
Alfentanil
50 mg/50 mL
Alteplase
100 mg/100 mL
Alteplase
100 mL
Amikacin
150 mg/100 mL
Amiodarone
Select, then Enter
Page
Up
3)
Use
to highlight
desired drug name.
When list does not contain
desired generic drug name
or group name select
 [Page Down] (or  [Page
Up]) until it shows, then
use
4)
A
Page
Down
Enter
MedSurg
Antibiotic
250 mg/500 mL
DOBUTamine
500 mg/500 mL
DOBUTamine
100 mg/250 mL
Docetaxel
___ ___/___ mL
DOPamine
400 mg/250 mL
DOPamine
800 mg/250 mL
DOPamine
25,000 units/500 mL
Heparin
Select, then Enter
Page
Up
Page
Down
Enter
to highlight choice.
Select  [Enter] to indicate selection and
advance to the Select Therapy screen.
System Operating Manual
Cancel/
Back
Cancel/
Back
5- 4
5) Therapies
Based on this selection, assume the hospital
has set the following rules for the Med/Surg
Area:
Soft upper limit of 8 mcg/kg/min
Hard upper limit of 12 mcg/kg/min
NOTE: The SOFT and HARD limits are not displayed.
However, the limit is provided if a value is programmed
outside the acceptable range. Typically, the pharmacy will set
the limit.
The Select Therapy screen
for Line A appears.
5)
Select  [Choose] to
select Dose Calculation
and continue.
A
PROGRAM
DOPamine
Dose Calculation
Loading Dose
Multistep
Select, then Choose
If selected drug has been
programmed with
established dosing units
and concentration, skip to
Step 8.
Choose
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
The Program Dose Calc
screen appears.
NOTE: Cursor defaults to package
insert (or hospital) recommended
dose units associated with the
selected drug.
5- 5
A
Program Dose Calc
DOPamine
mL/hr
mcg/kg/min
mcg/kg/hr
mcg/min
mcg/hr
mg/kg/hr
mg/min
mg/hr
grams/hr
ng/kg/min
units/kg/hr
units/min
units/hr
mUn/min
mEq/hr
Select, then Choose
Choose
6)
Back
Select  [Choose] to
continue. Or, use
to
change the units to use in
the delivery.
NOTE: Previously selected Drug Names and Delayed Start
entries will be cleared if entered prior to Therapy selection.
The Container
Concentration Selection
screen appears whenever
the selected Dose Units
are gram-based (for
example, grams, mg, mcg,
or ng), otherwise this
screen is skipped.
A
Program Dose Calc
DOPamine
Drug Conc in Container
mcg
mg
grams
Select, then Choose
Choose
Back
NOTE: Cursor defaults to package
insert (or hospital) recommended
concentration units associated with
the selected drug.
7)
Select  [Choose] to continue. Or, use
to
change the Container Concentration units to
use in the delivery.
System Operating Manual
5- 6
5) Therapies
The next page of the
Program Dose Calc screen
appears to provide for
entry of delivery program
parameters.
The Concentration and
Volume fields are filled in
per drug selection.
8)
Program Dose Calc
A
DOPamine
400 mg
Conc
Weight
250 mL
70 kg
Dose
VTBI
Duration
Rate
0
0
00: 00
0
mcg/kg/min
mL
hr : min
mL/hr
Enter value using keypad
Program
Options
Cancel/
Back
Use keypad to enter desired values. Once
each value is entered, use
next programming field.
to highlight the
NOTE: The Concentration elements and weight value must
be entered before the [SELECT] key allows access to
remaining fields.
9)
Continue to enter values
using the keypad, and
advancing to the next
field using
A
Program Dose Calc
DOPamine
Conc
Weight
Dose
VTBI
Duration
Rate
.
NOTE: As the Dose value is
entered, the Rate is automatically
calculated. To understand the
Automatic Calculation feature, see
Section 6, Examples of Automatic
Calculation.
400 mg
70 kg
10
0
00: 00
26.3
250 mL
mcg/kg/min
mL
hr : min
mL/hr
Enter value using keypad
Program
Options
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
10) Use
to scroll down to
the VTBI field.
11) Enter a value for VTBI
using the keypad.
5- 7
A
Program Dose Calc
DOPamine
Conc
Weight
400 mg
70 kg
Dose
VTBI
Duration
Rate
10
250
09: 30
26.3
250 mL
mcg/kg/min
mL
hr : min
mL/hr
Enter value using keypad
NOTE: As the VTBI value is
entered or changes, Duration is
automatically updated.
Program
Options
Cancel/
Back
NOTE: At this point, programming is complete unless
 [Program Options] are desired. See Section 6, Additional
Features for more information.
CAUTION: VERIFY DOSE, RATE, VTBI, AND
DURATION BEFORE PRESSING [START].
12) Press
.
Because the Dose falls
outside the soft limits, the
pump beeps three times
(Invalid Key Warning), and
generates the error
message:
A
Program Dose Calc
DOPamine
Conc
Weight
Dose
VTBI
Duration
Rate
400 mg
70 kg
10
250
09: 30
26.3
250 mL
mcg/kg/min
mL
hr : min
mL/hr
Dose > 8. Override?
“Dose > 8. Override?”
Yes
No
13) Select  [Yes].
NOTE: A SOFT limit override will be recorded in the History
Events Log.
System Operating Manual
5- 8
5) Therapies
This will bring up the
Program Confirmation
screen.
14) If Dose, Drug, Conc.,
Weight and Rate appear
correct, select  [Yes] to
begin program.
Program Dose Calc
A
MedSurg
Delivery will be:
Dose
Drug
Conc
Weight
Rate
10 mcg/kg/min
DOPamine
400 mg 250 mL
70 kg
26.3 mL/hr
Confirm Program?
Yes
No
NOTE: If the selected drug has
been pre-programmed with dosing units and concentration,
the concentration drug amount or diluent volume cannot be
changed whether delivering or stopped. The only way to
change to a different concentration is to clear the program.
However, if selected drug has not been pre-programmed (or
still operating with the DDL), the concentration can be
changed for a therapy.
The Main Delivery screen
appears displaying the
information just entered.
NOTE: The Therapy Type and
Drug are displayed as well as the
Dose Rate and Dose Units.
A PUMPING STOPPED B
DOPamine
Dose Calculation
26.3
Rate
mL/hr
0
0
Vol Inf
mL
Dose
0
10
mcg/kg/min
MedSurg
A
B
Options/
Vol Inf
System Operating Manual
Plum A+ Infusion System
5- 9
5.2 Dose Calc (mg/min on B)
DOSE CALCULATION - Allows programming
Dose Rates in alternative units of measure.
Dose Calculation can be used in Simple
Delivery, Loading Dose, and Multistep.
Clear ALL settings when changing patients or
multiple programming parameters.
1)
Select  [B] at the Main
Delivery Screen.
A PUMPING STOPPED B
DOPamine
Dose Calculation
26.3
Rate
mL/hr
0
0
Vol Inf
mL
Dose
0
10
mcg/kg/min
MedSurg
A
The Line B Programming
screen appears.
Select  [Therapy].
Options/
Vol Inf
B
PROGRAM
MedSurg
Mode
2)
B
Rate
VTBI
Duration
Piggyback
0
0
00:00
mL/hr
mL
hr : min
Change using Change Mode
Program Change
Therapy
Options
Mode
System Operating Manual
Cancel/
Back
5- 10
5) Therapies
The Drug List Screen
appears, in mainly
alphabetical order.
MedSurg
NOTE: Default entry is “No Drug
Selected”.
B
No Drug Selected
25 grams/500 mL
Albumin 5%
2.6 mg/50 mL
Aldesleukin
10 mg/250 mL
Alfentanil
50 mg/50 mL
Alteplase
100 mg/100 mL
Alteplase
100 mL
Amikacin
150 mg/100 mL
Amiodarone
Select, then Enter
Page
Up
3)
When list does not contain
desired generic drug name
or group name select
 [Page Down] (or
 [Page Up]) until it shows,
4)
Enter
MedSurg
Use
to highlight
desired drug name.
then use
choice.
Page
Down
Labetalol
Lepirudin
Lidocaine
Lidocaine
Lidocaine
Liposyn 10%
Liposyn 20%
Milrinone
Cancel/
Back
B
200 mg/200 mL
100 mg/250 mL
1 grams/250 mL
2 grams/500 mL
4 grams/500 mL
100 mL
500 mL
200 mcg/100 mL
Select, then Enter
Page
Up
Page
Down
Enter
Cancel/
Back
to highlight
Select  [Enter] to indicate selection and
advance to the Select Therapy screen.
System Operating Manual
Plum A+ Infusion System
The Select Therapy screen
for Line B appears.
5)
Select  [Choose] to
continue.
If selected drug has been
programmed with
established dosing units
and concentration, skip to
Step 8.
The Program Dose Calc
screen appears.
NOTE: Cursor defaults to package
insert (or hospital) recommended
dose units associated with the
selected drug.
5- 11
Lidocaine
Dose Calculation
Loading Dose
Multistep
Select, then Choose
Choose
Select  [Choose] to
continue. Or, use
to
change the units to use in
the delivery.
System Operating Manual
Cancel/
Back
Program Dose Calc
B
Lidocaine
mL/hr
mcg/kg/min
mcg/kg/hr
mcg/min
mcg/hr
mg/kg/hr
mg/min
mg/hr
grams/hr
ng/kg/min
units/kg/hr
units/min
units/hr
mUn/min
mEq/hr
Select, then Choose
Choose
6)
B
PROGRAM
Back
5- 12
5) Therapies
The Container
Concentration Selection
screen appears whenever
the selected Dose Units
are gram-based (for
example, grams, mg, mcg,
or ng) otherwise this
screen is skipped.
Program Dose Calc
B
Lidocaine
Drug Conc in Container
mcg
mg
grams
Select, then Choose
Choose
Back
NOTE: Cursor defaults to package
insert recommended concentration
units associated with the selected
drug.
7)
Select  [Choose] to continue. Or, use
to
change the Container Concentration units to
use in the delivery.
The next page of the
Program Dose Calc screen
appears to provide for
entry of delivery program
parameters.
8)
Use keypad to enter
desired values. Once
Program Dose Calc
B
Lidocaine
Conc
Mode
Dose
VTBI
Duration
Rate
2 grams
500 mL
Piggyback
0
0
00: 00
0
mg/min
mL
hr : min
mL/hr
Enter value using keypad
Program
Options
Cancel/
Back
entered, use
to
highlight the next field.
NOTE: If selected drug has established Rule Sets (for
example, non-blank concentration), the Mode field will be
highlighted upon entry to this screen.
System Operating Manual
Plum A+ Infusion System
9)
5- 13
To override the Piggyback Delivery Mode
default, scroll down to Mode using
select  [Change Mode].
, then
NOTE: Delivery Mode Option is available on Line B, its
default is Piggyback, and the Weight field is gone.
10) Continue entering
desired values using the
Program Dose Calc
Conc
keypad. Use
to
advance to the next field.
NOTE: When entering the Rate,
with a VTBI value entered, the
Dose and Duration fields are
automatically updated. To
understand the Automatic
Calculation feature, see
Section 6.7, Examples of
Automatic Calculation.
B
Lidocaine
Mode
Dose
VTBI
Duration
Rate
2 grams
500 mL
Concurrent
2
500
16 : 40
30
mg/min
mL
hr : min
mL/hr
Enter value using keypad
Program
Options
Cancel/
Back
NOTE: The Duration field temporarily changes to dashes
when the computed value is larger than what can be
displayed.
11) Continue entering the Rate value, if desired.
NOTE: As Rate is entered, the Duration and Dose are
automatically adjusted as individual numbers are entered.
NOTE: If the Duration value is changed, the Rate and Dose
are automatically adjusted.
NOTE: At this point, programming is complete unless
 [Program Options] are desired. See Section 6, Additional
Features for more information.
System Operating Manual
5- 14
5) Therapies
CAUTION: VERIFY DOSE, RATE, VTBI, AND
DURATION BEFORE PRESSING [START].
12) To start the delivery,
press
B
Program Dose Calc
MedSurg
.
Delivery will be:
This will bring up the
Program Confirmation
screen.
Dose
Drug
Conc
Weight
Rate
2 mg/min
Lidocaine
2 grams 500 mL
70 kg
30 mL/hr
Confirm Program?
Yes
No
13) If Dose, Drug, Conc.,
Weight, and Rate appear
correct, select  [Yes] to
begin program.
NOTE: If the selected drug has been pre-programmed with
dosing units and concentration, the concentration drug
amount or diluent volume cannot be changed whether
delivering or stopped. The only way to change to a different
concentration is to clear the program.
However, if selected drug has not been pre-programmed (or
still operating with the DDL), the concentration can be
changed for a therapy.
Upon
, the Main
Delivery Screen shows
delivery status for both A
and B lines.
A STOPPED PUMPING B
Dopamine
Dose Calculation
26.3
Rate
mL/hr
30
1
Vol Inf
mL
0.1
mcg/kg/min
NOTE: See Delivery Rate Range
in Section 9. The ratio of
concurrent rates has
recommendations specified in
Section 1.4.
Lidocaine
Dose Calculation
2
Dose
MedSurg
A
B
mg/min
Options/
Vol Inf
System Operating Manual
Plum A+ Infusion System
5- 15
5.3 Loading Dose
LOADING DOSE - Allows programming of an
initial infusion rate for a specific volume,
followed automatically by a maintenance rate
from the same container (for example, a fluid
challenge). If Dose Calc is used, the Loading
Dose and Maintenance Dose are in the same
unit of measure, over the same period of time
(mcg/min), from the same container.
Clear ALL settings when changing patients or
multiple programming parameters.
The Area Selection screen
will appear if your system
has been programmed with
the MedNet accessory.
Use
to select CCA and
bring you to the Main
Delivery Screen.
System Operating Manual
Area Selection
Any Hospital, USA
MM/DD/YY XXYYZZ- 123456
ICU
MedSurg
OR
Cardio
Urology
Psych
Renal
Neo ICU
OB/GYN
Oncol
Ad ICU
ER
Select, then Enter
Enter
5- 16
1)
5) Therapies
Select  [A] (or  [B]) at
the Main Delivery screen.
A STOPPED STOPPED B
0
Rate
mL/hr
0
0
Vol Inf
mL
0
MedSurg
Back
Prime
The selected Line (A or B)
Programming screen
appears.
2)
A
B
A
Options/
Vol Inf
PROGRAM
MedSurg
Select [Therapy].
Rate
0
mL/hr
VTBI
0
mL
00:00
Duration
hr : min
Enter Value using keypad
Program
Options
The Drug List Screen
appears, in mainly
alphabetical order.
A
NOTE: Default entry is “No Drug
Selected”. This process will guide
you through a “fluid challenge”, so
“No Drug Selected” will be entered.
3)
Therapy
Cancel/
Back
MedSurg
No Drug Selected
25 grams/500 mL
Albumin 5%
2.6 mg/50 mL
Aldesleukin
10 mg/250 mL
Alfentanil
50 mg/50 mL
Alteplase
100 mg/100 mL
Alteplase
100 mL
Amikacin
150 mg/100 mL
Amiodarone
Select, then Enter
Page
Up
Page
Down
Enter
Cancel/
Back
Select  [Enter] to
indicate selection and
advance to the Select
Therapy screen.
System Operating Manual
Plum A+ Infusion System
The Select Therapy screen
for Line A (or B) appears.
5- 17
A
PROGRAM
Dose Calculation
NOTE: This example shows line A
being programmed.
Loading Dose
Multistep
Select, then Choose
Choose
4)
5)
Use
to scroll down to
Loading Dose.
Select  [Choose] to
continue.
A
Cancel/
Back
PROGRAM
Dose Calculation
Loading Dose
Multistep
Select, then Choose
Choose
The next page of the
Program Loading Dose
screen appears.
6)
Select  [Choose] to
continue. Or, use
to
change the units to use in
the delivery.
System Operating Manual
Cancel/
Back
A Program Loading Dose
mL/hr
mcg/kg/min
mcg/kg/hr
mcg/min
mcg/hr
mg/kg/hr
mg/min
mg/hr
grams/hr
ng/kg/min
units/kg/hr
units/min
units/hr
mUn/min
mEq/hr
Select, then Choose
Choose
Back
5- 18
5) Therapies
The Loading Dose
Programming screen
appears.
7)
A Program Loading Dose
The default field is Rate.
Since a “Fluid Challenge”
is being performed in this
1
2
Rate
mL/hr
0
0
VTBI
mL
0
0
Duration
hr : min
00 : 00
00 : 00
Enter value using keypad
Program
Options
Cancel/
Back
example, press
to
advance to the VTBI field.
8)
Enter value using keypad.
A Program Loading Dose
1
2
Rate
mL/hr
0
0
VTBI
mL
250
0
Duration
hr : min
00 : 00
00 : 00
Enter value using keypad
Program
Options
9)
Use
to highlight the
next field.
10) Enter Duration using
keypad. The Rate value is
automatically calculated.
To understand the
Automatic Calculation
feature, see Section 6.7,
Examples of Automatic
Calculation.
Cancel/
Back
A Program Loading Dose
1
2
Rate
mL/hr
500
0
VTBI
mL
250
0
Duration
hr : min
00 : 30
00 : 00
Enter value using keypad
Program
Options
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
11) After the values for
loading dose Step 1 are
entered, use
to
highlight the maintenance
dose, Step 2.
5- 19
A Program Loading Dose
1
2
Rate
mL/hr
500
75
VTBI
mL
250
0
Duration
hr : min
00 : 30
00 : 00
Enter value using keypad
NOTE: The Loading Dose therapy
has two steps. The first is the
loading dose followed by the
maintenance dose. These words
will appear on the main screen as
each step is delivered.
12) Enter the set of desired
values for Step 2 of the
program.
13) Select  [Program
Options] to select a
Delayed Start or Standby.
NOTE: At this point, programming
is complete unless  [Program
Options] are desired. See Section
6, Additional Features for more
information.
System Operating Manual
Program
Options
Cancel/
Back
A Program Loading Dose
1
2
Rate
mL/hr
500
75
VTBI
mL
250
750
Duration
hr : min
00 : 30
10 : 00
Enter value using keypad
Program
Options
Cancel/
Back
5- 20
5) Therapies
NOTE: Nurse Callback enables an
alarm when a change in the
delivery on a line occurs such as
completing Step 1 and starting
Step 2. Or on line B, a piggyback
delivery is completed and line A is
starting its delivery.
A
Program Options
Loading Dose
Delay Start for 00:00 hr:min
Callback
No
Enter Value using keypad
Standby
14) Enter a delay time (less
than 24 hours) using the
keypad.
A
Enter
Cancel/
Back
Program Options
Loading Dose
Delay Start for 00:05 hr:min
NOTE: Not available if a delivery is
taking place on the line.
Callback
Yes
Change using Yes/No
NOTE: Nurse Callback cannot be
changed while a delivery is taking
place on the line.
Yes/No
Enter
Cancel/
Back
15) Select  [Enter] to accept the changes and
return to the Program Loading Dose screen.
NOTE:  [Cancel/Back] returns the fields to their original
value and displays the previous screen.
CAUTION:
VERIFY RATE,
BEFORE PRESSING [START].
VTBI, AND DURATION
16) To start the delivery, press
.
System Operating Manual
Plum A+ Infusion System
This will bring up the
Program Confirmation
screen.
17) If Drug and Rate appear
correct, select  [Yes] to
begin program.
5- 21
Program Loading Dose
A
MedSurg
Delivery will be:
No Drug Selected
500 mL/hr
250 mL
Drug
Rate
VTBI
!
Confirm Program?
Yes
The Main Delivery Screen
appears.
NOTE: The words “DELAYED” and
“Loading Dose” appear in the
upper-left corner. These indicate
the options which have been
selected.
After the programmed
delay period has expired,
the Plum A+ starts
“PUMPING”. This is
indicated where
“DELAYED” previously
was displayed.
No
A DELAYED STOPPED B
Loading Dose
500
Rate
mL/hr
0
0
Vol Inf
mL
0
!
MedSurg
Options/
Vol Inf
A PUMPING STOPPED B
Loading Dose
500
Rate
mL/hr
0
0
Vol Inf
mL
0
MedSurg
A
System Operating Manual
B
A
B
Options/
Vol Inf
5- 22
5) Therapies
After the Step 1 has
completed, the Main
Delivery Screen changes
to the second step.
NOTE: A flashing “Callback Line A”
message and the audio alarm
sound indicates activation of that
option.
A PUMPING STOPPED B
Maintenance Dose
75
Rate
mL/hr
0
250
Vol Inf
mL
0
MedSurg
N105 Callback Line A
B
A
Options/
Vol Inf
18) The user should acknowledge the Callback
message and stop the audio alarm by
pressing
.
Upon completion of
delivery, the screen shows
a flashing “Line A VTBI
complete” message and
the audible alarm sounds.
A
STOPPED B
KVO
Maintenance Dose
1
Rate
mL/hr
0
1000
Vol Inf
mL
0
MedSurg
NOTE: The KVO rate will change
to the rate of 1 mL/hr or less
depending on delivery rate and
“PUMPING” mode changes to
“KVO”. If Continue Rate option was
selected, pumping continues at
original rate.
19) Press
N161 Line A VTBI complete
A
B
Options/
Vol Inf
to stop alarm sound.
NOTE: Warning message continues to flash and audio alarm
will return after a two minute period of silence, unless delivery
is stopped or VTBI of last line is changed.
System Operating Manual
Plum A+ Infusion System
5- 23
5.4 Multistep Programming
MULTISTEP - Allows a sequential program to
deliver up to 10 steps; fluid volumes and
delivery rates may be programmed for each
step. The program may be entered based on
Rate and Volume or Volume and Time. If Dose
Calc is used, the delivery steps are in the same
unit of measure, over the same period of time,
from the same container.
Clear ALL settings when changing patients or
multiple programming parameters.
The Area Selection screen
will appear if your system
has been programmed with
the MedNet accessory.
Use
to select and bring
you to the Main Delivery
Screen.
System Operating Manual
Area Selection
Any Hospital, USA
MM/DD/YY XXYYZZ- 123456
ICU
MedSurg
OR
Cardio
Urology
Psych
Renal
Neo ICU
OB/GYN
Oncol
Ad ICU
ER
Select, then Enter
Enter
5- 24
1)
5) Therapies
Select  [A] at the Main
Delivery screen.
A STOPPED STOPPED B
0
Rate
mL/hr
0
0
Vol Inf
mL
0
MedSurg
Back
Prime
The Line A Programming
screen appears.
2)
A
B
A
Options/
Vol Inf
PROGRAM
MedSurg
Select  [Therapy].
Rate
0
mL/hr
VTBI
0
mL
00:00
Duration
hr : min
Enter Value using keypad
Program
Options
The Drug List Screen
appears, in mainly
alphabetical order.
A
NOTE: Default entry is “No Drug
Selected”. This selection may be
used later to remove an incorrect
or unwanted drug name from the
display.
Therapy
Cancel/
Back
MedSurg
No Drug Selected
25 grams/500 mL
Albumin 5%
2.6 mg/50 mL
Aldesleukin
10 mg/250 mL
Alfentanil
50 mg/50 mL
Alteplase
100 mg/100 mL
Alteplase
100 mL
Amikacin
150 mg/100 mL
Amiodarone
Select, then Enter
Page
Up
Page
Down
Enter
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
3)
Use
to highlight
desired drug name.
When list does not contain
desired drug name or drug
class name, select
 [Page Down] (or  [Page
Up]) until it shows, then
use
4)
5- 25
A
MedSurg
5 mg/100 mL
40 mg/50 mL
80 mg/100 mL
500 mg/100mL
100 mL
50 mL
Tirofiban
Tobramycin
Tobramycin
Vancomycin
VinCRIStine
VinCRIStine
Select, then Enter
Page
Up
Page
Down
Enter
Cancel/
Back
to highlight choice.
Select  [Enter] to indicate selection and
advance to the Select Therapy screen.
The Select Therapy screen
for Line A (or B) appears.
A
PROGRAM
VinCRIStine
Dose Calculation
NOTE: This example shows line A
being programmed.
Loading Dose
Multistep
Select, then Choose
Choose
5)
6)
Use
to scroll down to
Multistep.
Select  [Choose] to
continue.
A
Cancel/
Back
PROGRAM
VinCRIStine
Dose Calculation
Loading Dose
Multistep
Select, then Choose
Choose
System Operating Manual
Cancel/
Back
5- 26
5) Therapies
If selected drug has been programmed with
established dosing units and concentration,
skip to Step 9.
The Program Multistep
screen appears.
NOTE: Cursor defaults to package
insert recommended dose units
associated with the selected drug.
Program Multistep
A
VinCRIStine
mL/hr
mcg/kg/min
mcg/kg/hr
mcg/min
mcg/hr
mg/kg/hr
mg/min
mg/hr
grams/hr
ng/kg/min
units/kg/hr
units/min
units/hr
mUn/min
mEq/hr
Select, then Choose
7)
Use
key to highlight
the units to use in the
delivery.
8)
Select  [Choose] to
continue.
The Multistep
Programming screen
appears.
9)
Choose
Back
Program Multistep
A
VinCRIStine
Rate is the default field.
Enter value using keypad.
1
2
3
4
Rate
VTBI
Duration
mL/hr
50
0
0
0
mL
0
0
0
0
hr : min
00 : 00
00 : 00
00 : 00
00 : 00
Enter value using keypad
Program
Options
More
Steps
Cancel/
Back
System Operating Manual
Plum A+ Infusion System
10) Use
to highlight the
Duration or VTBI field.
NOTE: The VTBI value is
automatically computed when the
Duration value is entered. If VTBI
is entered, the Duration value is
automatically computed.
11) Use
to drop down to
Step 2, Rate field.
12) Enter the set of desired
values for Step 2 of the
program. Continue
process for each
additional Step.
NOTE: When Step 4 is
programmed, using [SELECT] to
advance will highlight another item
on this screen.
13) When Step 4 is
programmed, select
 [More Steps] to program
up to 10 steps.
NOTE: Using [SELECT] will not
advance you to the additional
steps.
System Operating Manual
5- 27
Program Multistep
A
VinCRIStine
1
2
3
4
Rate
VTBI
Duration
mL/hr
50
0
0
0
mL
50
0
0
0
hr : min
01 : 00
00 : 00
00 : 00
00 : 00
Enter value using keypad
Program
Options
More
Steps
Cancel/
Back
Program Multistep
A
VinCRIStine
1
2
3
4
Rate
VTBI
Duration
mL/hr
50
100
0
0
mL
50
0
0
0
hr : min
01 : 00
00 : 00
00 : 00
00 : 00
Enter value using keypad
Program
Options
More
Steps
Cancel/
Back
Program Multistep
A
VinCRIStine
1
2
3
4
Rate
VTBI
Duration
mL/hr
50
100
75
50
mL
50
825
75
50
hr : min
01 : 00
08 : 15
01 : 00
01 : 00
Enter value using keypad
Program
Options
More
Steps
Cancel/
Back
5- 28
5) Therapies
14) To set up Steps 5 through
10, enter desired values
as performed for Steps 1
through 4.
To see the previous steps,
select  [Prev Steps].
Program Multistep
A
VinCRIStine
5
6
7
8
9
10
Rate
VTBI
Duration
mL/hr
0
0
0
0
0
0
mL
0
0
0
0
0
0
hr : min
00 : 00
00 : 00
00 : 00
00 : 00
00 : 00
00 : 00
Enter value using keypad
Program
Options
Prev
Steps
Cancel/
Back
CAUTION: VERIFY RATE, VTBI,
AND DURATION BEFORE PRESSING
[START].
The Main Delivery Screen
displays Step 1 in the
upper-left corner.
NOTE: In units other than mL/hr,
the Dose rate and units also will be
displayed.
A PUMPING STOPPED B
VinCRIStine
Step 1
50
Rate
mL/hr
0
27.5
Vol Inf
mL
0
B
A
Example of Multistep
Screen Pumping on Step 2.
15) To change a program
parameter while pumping,
select  [A].
Options/
Vol Inf
A PUMPING STOPPED B
VinCRIStine
Step 2
100
Rate
mL/hr
0
652
Vol Inf
mL
0
A
B
Options/
Vol Inf
System Operating Manual
Plum A+ Infusion System
NOTE: The “*” in a step number
field indicates the step is delivering
or “d” indicates each completed
step.
16) Enter a value using the
keypad.
5- 29
Program Multistep
A
VinCRIStine
d
3
4
Rate
VTBI
Duration
mL/hr
50
100
75
50
mL
50
825
75
50
hr : min
01 : 00
08 : 15
01 : 00
01 : 00
Enter value using keypad
Program
Options
If Rate value is changed,
the Duration will
automatically change.
CAUTION: VERIFY RATE, VTBI,
AND DURATION BEFORE PRESSING
[START].
NOTE: The Values are now
updated on the Main Delivery
Screen.
The pump reverts to KVO
when last step completes.
The last step can be
restarted by entering a new
VTBI value.
System Operating Manual
Cancel/
Back
Program Multistep
A
VinCRIStine
d
NOTE: Only the current delivering
step and future steps can be
changed.
More
Steps
3
4
Rate
VTBI
Duration
mL/hr
50
125
75
50
mL
50
825
75
50
hr : min
01 : 00
06 : 36
01 : 00
01 : 00
Enter value using keypad
Program
Options
More
Steps
Cancel/
Back
A PUMPING STOPPED B
VinCRIStine
Step 2
125
Rate
mL/hr
0
658
Vol Inf
mL
0
A
B
Options/
Vol Inf
5- 30
5) Therapies
NOTES
System Operating Manual
Plum A+ Infusion System
6)
6- 1
Additional Features
6.1 Simple Delivery Using Delayed Start
1)
Before or after entering
the simple delivery
program, select
 [Program Options].
Mode Concurrent
Rate
VTBI
NOTE: To program a Delayed Start
using a Therapy (that is, Dose
Calc) you must first select which
line you want (A or B), next select
[Therapy], and then [Program
Options]. If you program the
Delayed Start first, it will be cleared
upon entry into Therapy mode.
The Default screen for
Program Options appears.
B
PROGRAM
MedSurg
Duration
5
250
50:00
mL/hr
mL
hr : min
Change using Change Mode
Program Change
Therapy
Options
Mode
Program Options
Cancel/
Back
B
Delay Start for 00:00 hr:min
Callback
No
Enter Value using keypad
Standby
System Operating Manual
Enter
Cancel/
Back
6- 2
6) Additional Features
2)
Enter values for desired
hours and/or minutes.
3)
Select  [Enter] to confirm
delayed start.
CAUTION: VERIFY RATE, VTBI,
AND DURATION BEFORE PRESSING
[START].
4)
Program Options
B
Delay Start for 01:00 hr:min
Callback
No
Enter Value using keypad
Standby
Enter
Cancel/
Back
Press
to confirm
programming.
Line B is delayed for the
time entered.
NOTE: Delayed line drip indicator
is solid, not flashing. It will begin
flashing when actually pumping.
A PUMPING DELAYED B
125
Rate
mL/hr
5
850
Vol Inf
mL
0
!
!
MedSurg
A
B
Options/
Vol Inf
System Operating Manual
Plum A+ Infusion System
6- 3
6.2 Piggyback with Nurse Callback
1)
After programming in
desired values for both
lines, select [Program
Options].
Mode
Piggyback
Rate
VTBI
NOTE: To set a Nurse Callback,
the pump must be stopped. This
function can be selected either
before or after entering the
Piggyback delivery program.
The default screen for
Program Options appears.
B
PROGRAM
MedSurg
Duration
200
100
00:30
mL/hr
mL
hr : min
Enter value using keypad
Program
Options
Therapy
Cancel/
Back
Program Options
B
Delay Start for 00:00 hr:min
Use
to highlight
“Callback” field and select
[Yes/No], if necessary to
obtain “Yes”, then select
 [Enter].
Callback
Yes
Change using Yes/No
Yes/No
Enter
Cancel/
Back
NOTE: Callback default of Yes or
No is a biomedical setting and
must be configured using the
Hospira MedNet accessory.
CAUTION:
V ERIFY RATE,
BEFORE PRESSING [START].
System Operating Manual
VTBI, AND DURATION
6- 4
2)
6) Additional Features
Press
to confirm
program setting and
return to Main Delivery
screen.
B
PROGRAM
MedSurg
Mode
Piggyback
200
100
00:30
Rate
VTBI
Duration
mL/hr
mL
hr : min
Enter value using keypad
Program
Options
At end of Piggyback
delivery, with Callback
enabled for the line,
Callback alarm is issued.
3)
Press
alarm.
to clear
Cancel/
Back
Therapy
A PUMPING STOPPED B
5.5
Rate
mL/hr
200
0.3
Vol Inf
mL
100
!
!
MedSurg
N104 Callback Line B
A
B
Options/
Vol Inf
6.3 Possible Non-Delivery Programmed
NOTE: Whenever a valid [START]
key is pressed, the device checks
the delivery program(s) for nondelivery conditions (such as Line B
Piggyback without Line A or
delayed start) that could permit a
period of non-delivery. If so, the
display presents this warning
screen.
1)
B
PROGRAM
Attention: Line A is stopped or
delayed. Line B in piggyback mode
gives no KVO or alarm at dose end.
Continue anyway?
Yes
No
Select  [Yes] to continue
with delivery. Or, select  [No] to cancel.
System Operating Manual
Plum A+ Infusion System
6- 5
6.4 Using the Standby Feature
Standby is a feature that
enables the clinician to
program the pump up to
23: 59 minutes in advance
of starting.
1)
If Line A is infusing,
select  [A] or  [B] to
access program screen of
line to be placed on
Standby.
2)
Select  [Program Options].
3)
Select  [Standby].
4)
Confirm the information
displayed is correct, then
select  [Yes] to place
program on Standby
mode.
Program Dose Calc
A
DOPamine
Conc
Weight
400 mg
70 kg
Dose
VTBI
Duration
Rate
10
250
09: 30
26.3
250 mL
mcg/kg/min
mL
hr : min
mL/hr
Enter value using keypad
Program
Options
Cancel/
Back
Program Dose Calc
A
MedSurg
Delivery will be:
Dose
Drug
Conc
Weight
Rate
10 mcg/kg/min
DOPamine
400 mg 250 mL
70 kg
26.3 mL/hr
Put delivery in Standby?
NOTE: This example screen
shows a Dose Calculation Program
with a Standby. It looks similar to
the Program Confirmation screen
with the substitution of “Put
delivery in Standby” replacing
“Confirm Program”. Selecting
[Yes] confirms both the Program
and the Standby.
System Operating Manual
Yes
No
6- 6
5)
6) Additional Features
Press
to remove
Standby and start the
infusion.
A STANDBY STOPPED B
DOPamine
Dose Calculation
26.3
Rate
mL/hr
0
0
Vol Inf
mL
0
10
mcg/kg/min
MedSurg
B
A
Options/
Vol Inf
6.5 Select Option- Volumes Infused,
Pressure/Post Infusion Rate,
and Lighting/Contrast
1)
To select Options screen,
select  [Options/Vol Inf].
A PUMPING STOPPED B
DOPamine
Dose Calculation
5.5
Rate
mL/hr
0
393
Vol Inf
mL
0
MedSurg
B
Options/
Vol Inf
OPTIONS
B
A
2)
Use
to highlight an
option.
A
Release 12.x - xx/xx/xx
Volumes Infused
Pressure/Post Infusion Rate
3)
Select  [Choose] to
select the Volumes
Infused screen.
Lighting/Contrast
Any Hospital, USA
MM/DD/YY XXYYZZ-123456
Select, then Choose
Choose
Back
System Operating Manual
Plum A+ Infusion System
This will bring up the
Volumes Infused screen
which defaults to Total
Volume.
4)
5)
Use
or B.
to scroll to Line A
to highlight and
press
A
B
OPTIONS
DOPamine
Dose Calculation
Volumes Infused
Line A
Line B
Total Vol
0 mL
0 mL
393 mL
Press CLEAR to clear value
Enter
To reset Line A (or B)
Volume Infused,
use
6- 7
.
A
Cancel/
Back
B
OPTIONS
DOPamine
Dose Calculation
Volumes Infused
Line A
Line B
Total Vol
0 mL
0 mL
393 mL
Press CLEAR to clear value
6)
To restore the cleared
quantity, select
 [Cancel/Back].
7)
To reset all volumes, use
to highlight Total Vol,
Enter
A
Cancel/
Back
B
OPTIONS
DOPamine
Dose Calculation
Volumes Infused
then press
8)
.
To restore all quantities,
select  [Cancel/Back]
softkey.
System Operating Manual
Line A
Line B
Total Vol
0 mL
0 mL
0 mL
Press CLEAR to clear value
Enter
Cancel/
Back
6- 8
9)
6) Additional Features
When clearing of quantities is completed,
select  [Enter] to return to the Main Delivery
screen.
10) Select  [Options/Vol Inf]
from the Main Delivery
screen to return to the
Options screen.
A
B
OPTIONS
Release 12.x - xx/xx/xx
Volumes Infused
Pressure/Post Infusion Rate
Lighting/Contrast
Any Hospital, USA
MM/DD/YY XXYYZZ-123456
11) Use
to highlight the
Pressure/Post Infusion
Rate option.
Select, then Choose
Choose
Back
12) Select  [Choose] to continue.
NOTE: Prior to changing Pressure/Post Infusion Rate, pump
must be stopped.
13) Use
to highlight
Continue Rate or Distal
Pressure Limit field.
14) Continue Rate allows a
choice when VTBI is
completed. Select
 [KVO/Rate].
A
B
OPTIONS
DOPamine
Dose Calculation
Pressure/Post Infusion Rate
Continue Rate
KVO
Distal Pressure Limit
6 psi
Distal Pressure
0 psi
Change using KVO/Rate
KVO/
Rate
Enter
Cancel/
Back
•
KVO - The pump will revert to a fixed KVO of 1 mL/hr
or the last programmed Rate, whichever is less.
•
Rate - The pump will continue at the Rate programmed.
NOTE: Option will be for both line A and line B selections.
System Operating Manual
Plum A+ Infusion System
6- 9
15) To change Distal Pressure Limit when
highlighted, enter value between 1 and 15.0
psi.
16) Select  [Enter] to keep changes and return to
the Main Delivery screen, or  [Cancel/Back] to
restore original values and return to the
Options screen.
NOTE: Continue Rate default of KVO or Rate is a biomedical
setting and must be configured using the Hospira MedNet
accessory.
17) Select  [Options/Vol Inf]
from the Main Delivery
screen to return to the
Options screen.
A
B
OPTIONS
Release 12.x - xx/xx/xx
Volumes Infused
Pressure/Post Infusion Rate
Lighting/Contrast
Any Hospital, USA
MM/DD/YY XXYYZZ-123456
18) Use
to highlight
Lighting/Contrast Option.
Select, then Choose
Choose
Back
19) Select  [Choose] to
continue.
20) Press
to highlight
Backlight Intensity or
Display Contrast.
21) While viewing display for
desired effect, select
either  [Increase Setting]
or  [Decrease Setting] to
change level.
System Operating Manual
A
OPTIONS
B
Lighting/Contrast
Backlight Intensity
Display Contrast
Use Inc/Decrease Settings
Decrease Increase
Setting Setting
Enter
Cancel/
Back
6- 10
6) Additional Features
22) Select [Enter] to keep change(s) and return
to the Main Delivery screen, or  [Cancel/Back]
to restore previous settings and return to the
Options screen.
6.6 Variable Rate Cap
NOTE: Variable Rate Cap is a biomed programmable item to
set the minimum and maximum rate values to be accepted by
the device. The clinician cannot change it once biomed has
programmed it. It must be configured using the Hospira
MedNet accessory.
6.7 Examples of Automatic Calculation
AT STARTUP
Initial programming allows the clinician to enter two of the three
programming parameters (Rate, VTBI, or Duration) and the third
is automatically calculated. (Refer to table below)
1st Action
enter RATE
enter VTBI
enter RATE
2nd Action
enter VTBI
enter DURATION
enter DURATION
[AUTOCALC]
[DURATION]
[RATE]
[VTBI]
WHILE RUNNING (TITRATION)
Changing two parameters after startup of the infusion will allow
for the re-calculation of the third parameter.
System Operating Manual
Plum A+ Infusion System
6- 11
NOTE: VTBI will not be re-calculated if the Rate and Duration
are changed. VTBI must be cleared and then the new VTBI
re-entered. The new VTBI will automatically calculate a new
Rate.
1st Action
2nd Action
[AUTOCALC]
change RATE
change RATE
change VTBI
change DURATION
change VTBI
change RATE
keep VTBI
change VTBI
keep RATE
keep VTBI
change DURATION
change DURATION
[DURATION]
[DURATION]
[DURATION]
[RATE]
[RATE]
Recalculates
[RATE] based on
previous VTBI and
new DURATION
AT KVO
Audible KVO alarm will sound, clinician will need to re-set the
appropriate settings.
1st Action
enter VTBI
enter DURATION
change RATE
enter DURATION
enter VTBI
change RATE
2nd Action
keep RATE
keep RATE
enter VTBI
enter VTBI
enter DURATION
change DURATION
System Operating Manual
[AUTOCALC]
[DURATION]
[VTBI]
[DURATION]
[DURATION]
[RATE]
[VTBI]
6- 12
6) Additional Features
NOTES
System Operating Manual
Plum A+ Infusion System
7- 1
7) Alarms and Troubleshooting
7.1 Warning Messages
CORRECTIVE
ACTION
MESSAGE
POSSIBLE CAUSE
Stop delivery then turn
off
Attempting to turn the
pump off while a
delivery is in progress.
Stop all lines, then turn
pump off.
Warning: Replace
battery
The battery current
charge is greater than
200 mA/hr.
Replace battery.
The battery voltage is
less than the depleted
threshold and charge
level is higher than the
low charge threshold.
Warning: Charger
Service
The charging circuitry
is not behaving as
expected (charge
voltage is not
changing) and can
reduce battery life.
Silence key is pressed.
Warning: Low Battery
Pump not plugged in to
AC power.
Plug into AC power,
only about 30 minutes
of battery life remains.
NOTE: Other error and warning messages will occur
when appropriate for the current selection context. For
instance, when a change to a required parameter would
result in clearing some delivery settings, the warning
message will appear when that field is selected. When an
input error has just been made, the three quick beeps of
an Invalid Key Warning will sound and an appropriate
System Operating Manual
7- 2
7) Alarms and Troubleshooting
warning message will be shown to explain the problem.
All such messages will be cleared or replaced by another
message upon the next valid input key press.
7.2 Response to Alarms
1. Disable Lockout by confirming back switch is in the down
position or press the decimal key followed by 9, 6, and 3 on
the keypad.
2. Press [SILENCE] key.
3. Identify/Observe Alarm condition.
4. Correct Alarm condition (see following tables).
5. Press [START] to resume infusion.
NOTE: Alarm messages begin with an alphanumeric
code for tracking purposes only. If troubleshooting does
not correct the problem, record the code number and
contact technical support.
System Operating Manual
Plum A+ Infusion System
7- 3
GENERAL ALARMS
CODE
MESSAGE
POSSIBLE CAUSE
CORRECTIVE
ACTION
N100
Unrecognized
cassette
Attempting to use
unrecognized cassette.
Turn off or insert
recognized cassette.
N101
No Action
Alarm
Pump programming
incomplete.
Press [START] or
continue
programming.
N102
Infuser Idle 2
Minutes
Pump is ON without
operator input.
Begin programming
or turn pump OFF.
Standby time has
elapsed.
Re-enter all
programmed data.
N103
Memory
Failure
The pump did not
accept the previous
programmed data.
Re-enter all
programmed data.
N230
Prox Air,
Backprime
When the total
proximal air detected
exceeds the limit.
Check for clamps, or
empty containers on
line A or B. Correct
as necessary.
Backprime into line B
tubing or syringe.
N180,
N181,
N186
Distal
Occlusion
Distal line kinked, IV
site clotted or
positional, pressure
limit set too low.
Check distal tubing,
check IV site, reset
pressure limit.
See page 1-14 for
detailed instructions
for avoiding a bolus
following a distal
occlusion.
N187
Neg Distal
Occlusion
Pump too high above
patient or defective
set.
Lower pump or
replace set.
N233,
N234
Distal Air
When air is detected at
the distal sensor and
exceeds the limit.
Remove and reprime
cassette using
standard technique.
System Operating Manual
7- 4
7) Alarms and Troubleshooting
CODE
MESSAGE
POSSIBLE CAUSE
CORRECTIVE
ACTION
N250
Door open
while pumping
Pump door opened
while operating.
Close door with
cassette inserted.
N251
Cassette Test
Failure
Faulty cassette,
proximal or distal
occlusion or air in
cassette detected at
start up.
Check clamps,
manually reprime set,
close door.
Backprime into line B
tubing or syringe if
appropriate. If alarm
recurs on retest,
replace set. If alarm
repeats, replace
pump.
N252
Depleted
Battery
Too much time on
battery power.
Plug into AC (mains)
power.
N253
Hard lockout
Violation
The use of the [STOP]
key during delivery, or
opening the door,
while lockout is
enabled.
Unlock lockout
switch.
N254
Hard lockout
Enabled
Pressing of any key
except [STOP] during
delivery while any
alarm is active and
lockout is enabled.
Unlock lockout
switch.
N255
Soft lockout
Violation
The use of the [STOP]
key during delivery, or
opening the door,
while lockout is
enabled.
Unlock lockout by
pressing the decimal
key, followed by 9, 6,
and 3 on the keypad.
N256
Soft lockout
Enabled
Pressing of any key
except [STOP] during
delivery while any
alarm is active and
lockout is enabled.
Unlock lockout by
pressing the decimal
key, followed by 9, 6,
and 3 on the keypad.
System Operating Manual
Plum A+ Infusion System
7- 5
LINE A ALARMS
CORRECTIVE
ACTION
CODE
MESSAGE
POSSIBLE CAUSE
N105
Callback Line
A
Alarm programmed by
user. Change in
delivery for Loading
Dose to Maintenance
Step or for any step in
Multistep therapy
provided the step is
not the last step.
Press [SILENCE].
N161
Line A VTBI
complete
VTBI complete on line
A.
Program new VTBI.
N185
Prox Occl A At
Startup
Proximal line
obstructed, line A
container (or syringe)
disconnected or
obstructed during nondelivery (startup).
Examine line A for
kinks or closed
clamps. If there are
closed clamps, open
the clamps. Then,
open and close door.
Continue
programming.
Replace set if
problem persists.
If clamps are not
opened prior to
completion of
cassette test, peak
proximal occlusion
may recur.
For syringe, select
 [Backprime].
System Operating Manual
7- 6
7) Alarms and Troubleshooting
CORRECTIVE
ACTION
CODE
MESSAGE
POSSIBLE CAUSE
N184,
N190,
N191
Prox Occl A /
Air
Proximal line
obstructed, line A
container disconnect
or obstruction.
Examine line A for
kinks, closed clamps,
or air in cassette.
N232
Prox Air A,
Backprime
When proximal air
detected exceeds the
limit for the line.
Check for clamps, or
empty container.
Correct as
necessary.
Backprime into line B
tubing or syringe.
System Operating Manual
Plum A+ Infusion System
7- 7
LINE B ALARMS
POSSIBLE
CAUSE
CORRECTIVE
ACTION
Callback
Line B
Alarm programmed
by user. Change in
delivery for piggyback
delivery, Loading
Dose to Maintenance
Step, or for any step
in Multistep” therapy
provided the step is
not the last step.
Press [SILENCE].
N160
Line B VTBI
complete
VTBI complete on line
B.
Program new VTBI.
N183
Prox Occl B
At Startup
Proximal line
obstructed, line B
container (or syringe)
disconnected or
obstructed during
non-delivery (startup).
Examine line B for
kinks or closed clamps.
If there are closed
clamps, open the
clamps. Then, open
and close door.
Continue
programming. Replace
set if problem persists.
CODE
MESSAGE
N104
If clamps are not
opened prior to
completion of cassette
test, peak proximal
occlusion may recur.
For syringe, select
 [Backprime].
System Operating Manual
7- 8
7) Alarms and Troubleshooting
CODE
MESSAGE
N182,
N188,
N189
Prox Occl B
/ Air
N231
Prox Air B,
Backprime
POSSIBLE
CAUSE
CORRECTIVE
ACTION
Proximal line
obstructed, line B
container
disconnected or
obstructed.
Examine line B for
kinks, closed clamps,
or air in cassette.
When proximal air
detected exceeds the
limit for the line.
Check for clamps, or
empty container.
Correct as necessary.
Backprime into line B
tubing or syringe.
Occlusion caused by
empty container,
backprime into line B
tubing or syringe.
MALFUNCTIONS
CODE
MESSAGE
E300 or
higher
Malfunction
POSSIBLE
CAUSE
CORRECTIVE
ACTION
A failure has occurred
in the pump’s internal
systems.
Record Malfunction
error code. Pump
must be turned OFF
to clear malfunction.
If alarm malfunction
repeats, replace
pump.
System Operating Manual
Plum A+ Infusion System
7- 9
7.3 General Messages
MESSAGE
POSSIBLE CAUSE
Cannot Standby in
Piggyback
Selection of
CORRECTIVE
ACTION
Select  [Cancel/
 [Standby] when
Back].
Line B is in Piggyback
Mode.
Cannot Standby with
Delay
Selection of
 [Standby] when
Delay time was
entered for program.
 [Cancel/Back].
Changing Area clears
program
Displays when other
than last-used Care
Area is highlighted.
N/A
Change Conc clears
entries
A therapy delivery
which has been
stopped and drug
amount value is
selected. This is
displayed before any
screen or field
message.
User can enter new
Concentration using
keypad, or press
[CLEAR] then make
new entry.
Change therapy clears
entries
A therapy delivery
which has been
stopped and user
highlights another
therapy for the same
line.
Change units clears
entries
A therapy delivery
which has been
stopped and user
highlights another
concentration unit for
the same line.
System Operating Manual
User can select
 [Back] to exit, or
use [SELECT] arrows
to highlight a new
value.
User can select
 [Back] to exit, or
use [SELECT] arrows
to highlight a new
value.
7- 10
7) Alarms and Troubleshooting
CORRECTIVE
ACTION
MESSAGE
POSSIBLE CAUSE
Change Vol clears
entries
A therapy delivery
which has been
stopped and diluent
value is selected. This
is displayed before any
screen or field
message.
User can enter new
Concentration volume
using keypad, or press
[CLEAR] then make
another entry.
Concurrency alert
Attempt to start a
multistep or loading
dose delivery whose
later steps would
exceed concurrent
delivery limit if delivery
proceeds.
User can enter new
values using number
keypad, or use
[SELECT] arrows to
move to another field
to change the entry.
User can also press
[CLEAR].
System Operating Manual
Plum A+ Infusion System
7- 11
CORRECTIVE
ACTION
MESSAGE
POSSIBLE CAUSE
Concurrency violation
Attempt to start a
second line with a
delivery rate that would
exceed concurrent
delivery upper limit
immediately. Or,
concurrent delivery
attempt and rate for
the second line is less
than concurrent
delivery lower limit.
Takes precedence over
“Rate must be > n mL/
hr” message. The
combined delivery rate
must fall within the
range of 1.0 mL/hr –
500 mL/hr or CCAspecific Maximum
Volumetric Rate, with
0.5 mL/hr minimum per
line.
User can enter new
values using number
keypad, or use
[SELECT] arrows to
move to another field
to change the entry.
User can also press
[CLEAR].
Decimal point not
allowed
Attempt to input
Decimal point when
either not used in field
or a three-digit whole
number already input.
Press [CLEAR]
Hardkey.
System Operating Manual
7- 12
7) Alarms and Troubleshooting
CORRECTIVE
ACTION
MESSAGE
POSSIBLE CAUSE
Dose > [X.xx].
Override?
Attempt to start
program with
parameter that has
caused the Dose (or
Rate, if mL/hr program)
to be greater than the
upper soft limit
[uuuuuuuu] for the
selected drug and
CCA. Also includes
placing program in
Standby, and restarting a stopped
program.
May be overridden by
selecting  [Yes].
Cleared by pressing of
[NUMERIC KEYS], [.],
[SELECT], [CLEAR] or
[STOP] hard keys, or
 [Yes/No] softkeys.
Also cleared by the
[ON/OFF] key when
the line is stopped.
Dose < [X.xx].
Override?
Attempt to start
program with
parameter that has
caused the Dose (or
Rate, if mL/hr program)
to be less than the
lower soft limit [llllllll]
for the selected drug
and CCA. Also
includes placing
program in Standby,
and re-starting a
stopped program.
May be overridden by
selecting  [Yes].
Cleared by pressing of
[NUMERIC KEYS], [.],
[SELECT], [CLEAR] or
[STOP] hard keys, or
 [Yes/No] softkeys.
Also cleared by the
[ON/OFF] key when
the line is stopped.
Hard Lockout Enabled
The Lockout Switch
has been enabled, no
Alarm is active, and
any key besides Stop
is pressed.
Disable the Lockout
switch located on the
back of the device.
(See Section 3)
System Operating Manual
Plum A+ Infusion System
7- 13
CORRECTIVE
ACTION
Select  [Cancel/
MESSAGE
POSSIBLE CAUSE
Illegal when Line
Delivering
Attempt to select
therapy other than
Dose Calculation while
a Basic program is
delivering on this line.
Input digits > max
allowed
Attempt to input digit
that would exceed the
number of decimal
places allowed for
defined value except
Dose and Rate.
Press [CLEAR]
hardkey.
Input value > max
allowed
Attempt to input
number that would
cause field to exceed
its defined limit. In the
Drug amount, Diluent
amount, VTBI,
Duration, Patient
Weight, Distal
pressure, and Delayed
Start time fields, the
Software shall display
‘---‘, and the user must
press the Clear hard
key and input a valid
value.
Press [CLEAR]
hardkey.
Maximum value
reached
The display contrast/
intensity has reached
its maximum value.
 [Enter] or
[Cancel/Back].
Minimum value
reached
The display contrast/
intensity has reached
its minimum value.
 [Enter] or
[Cancel/Back].
System Operating Manual
Back] or press
[CLEAR]. Pressing
[CLEAR] invokes
another message.
User can select
User can select
7- 14
7) Alarms and Troubleshooting
CORRECTIVE
ACTION
MESSAGE
POSSIBLE CAUSE
No delivery
programmed
Delivery attempt at
Main Delivery Screen
when A and B have
both Rate and VTBI
equal to zero (no
delivery programmed).
Select a line to
program, or
 [Options] or
 [Backprime].
Rate must be > 0 mL/
hr
Delivery attempt when
VTBI is non-zero but
rate is zero.
Use number keypad to
enter a value.
Soft Lockout Enabled
While the Soft Lockout
is enabled and no
Alarm is active, either
1) any key besides
Stop is pressed during
delivery, or 2) any key
is pressed while
stopped.
Disable the Soft
Lockout.
(See Section 3)
VTBI must be > 0
Delivery attempt when
rate is non-zero but
VTBI is zero.
Use number keypad to
enter a value.
Value is too high
Attempt to move cursor
from field whose input
value is too high.
Use number keypad to
enter a value.
Value is too low
Attempt to move cursor
from field requiring a
non-default value.
Use number keypad to
enter a value.
Weight change affects
Line A/B
Selecting the weight
field on line while a
weight-based program
is entered on other
line.
Use number keypad to
enter a value.
Minimum Dose X.xx
Attempt to start
program with Dose
less than lower hard
Dose limit n.nn.
Use number keypad to
enter a value.
System Operating Manual
Plum A+ Infusion System
MESSAGE
POSSIBLE CAUSE
Maximum Dose X.xx
Attempt to start
program with Dose
greater than upper
hard Dose limit n.nn.
Attempt to input a
Dose greater than the
upper Hard Limit.
7- 15
CORRECTIVE
ACTION
The Software will
display ‘---‘, and the
user must press the
[CLEAR] hard key and
input a valid value.
Minimum Rate X mL/hr
Attempt to start mL/hr
program with Rate less
than lower hard Dose
limit nn.n.
Use number keypad to
enter a value.
Maximum Rate X mL/
hr
Attempt to start mL/hr
program with Rate
greater than the upper
Hard Limit or CCA
Maximum Volumetric
Rate n.
The Software will
display ‘---‘, and the
user must press the
[CLEAR] hard key and
input a valid value.
Attempt to input a Rate
greater than the upper
Hard Limit or CCA
Maximum Volumetric
Rate n.
System Operating Manual
7- 16
7) Alarms and Troubleshooting
NOTES
System Operating Manual
Plum A+ Infusion System
8)
8- 1
Cleaning, Maintenance,
and Storage
The cleaning, maintenance, and storage of the Plum A+ are
described in this section.
CLEANING AND SANITIZING
For proper maintenance of the Plum A+, observe the following
cleaning and sanitizing guidelines.
Establish a routine weekly schedule for cleaning the pump. To
clean, proceed as follows:
•
Turn the Plum A+ off using the [ON/OFF] switch
•
Disconnect from AC (mains) power
The exposed surfaces of the Plum A+ may be cleaned with a lintfree cloth dampened by one of the recommended cleaning
solutions in the following list or mild, nonabrasive soapy water.
Clean the cassette door with a soft, lint-free cloth, dampened with
one of the cleaning agents listed in the following table, or a mild
solution of soapy water. Use a small non-abrasive brush to aid in
cleaning the infusion system housing and subsystem chassis
components. To thoroughly clean the cassette receptacle,
disengage the cassette door from the door latch by pressing the
door release tab.
CAUTION:
DO NOT ALLOW CLEANING SOLUTIONS TO
SATURATE THE AIR-IN-LINE DETECTORS OR ENTER THE DEVICE
WHEN CLEANING THE AIR-IN-LINE DETECTORS.
System Operating Manual
8- 2
8) Cleaning, Maintenance, and Storage
CLEANING
SOLUTION
MANUFACTURER
PREPARATION
CoverageTMHBV
Steris Corporation, A
division of Calgon
Vestal Laboratories
Per manufacturer's
recommendation
Formula C TM
Diversey Corporation
Per manufacturer's
recommendation
DispatchTM
Caltech Industries
Per manufacturer's
recommendation
PreciseTM
Caltech Industries
Per manufacturer's
recommendation
Household bleach
Various
Per hospital
procedures; do not
exceed one part
bleach in ten parts
water
Manu-KlenzTM
Calgon Vestal
Laboratories
Per manufacturer's
recommendation
SporicidinTM
Sporicidin International
Per manufacturer's
recommendation
Super EdisoniteTM
S. M. Edison Co.
Per manufacturer's
recommendation
On a routine basis, clean all of the elements behind the cassette
door using cotton-tipped swabs saturated with cleaning solution.
The cassette door may be unlatched from the door handle to
facilitate cleaning.
To unlatch the cassette door from its handle, tilt the device back,
open the cassette door, then push the door release tab to open
the door fully.
System Operating Manual
Plum A+ Infusion System
8- 3
CAUTION: T O AVOID MECHANICAL OR ELECTRONIC
DAMAGE, DO NOT IMMERSE THE PLUM A+ IN ANY FLUIDS OR
CLEANING SOLUTIONS.
CAUTION:
DO NOT SPRAY CLEANING SOLUTIONS TOWARD
ANY OPENING IN THE INSTRUMENT.
CAUTION: C E R T A I N C L E A N I N G A N D S A N I T I Z I N G
SOLUTIONS MAY SLOWLY DEGRADE COMPONENTS MADE FROM
SOME PLASTIC MATERIALS. USING ABRASIVE CLEANERS OR
CLEANING SOLUTIONS NOT RECOMMENDED BY HOSPIRA MAY
RESULT IN PRODUCT DAMAGE. DO NOT USE COMPOUNDS
CONTAINING COMBINATIONS OF ISOPROPYL ALCOHOL AND
DIMETHYL BENZYL AMMONIUM CHLORIDE.
CAUTION: N EVER USE SHARP OBJECTS SUCH AS
FINGERNAILS, PAPER CLIPS, OR NEEDLES TO CLEAN ANY PART
OF THE PUMP.
CAUTION: DO NOT STERILIZE BY HEAT, STEAM, ETHYLENE
(ETO), OR RADIATION.
OXIDE
CAUTION: T O A VO ID PU MP D AM AG E , CL EAN ING
SOLUTIONS SHOULD ONLY BE USED AS DIRECTED. THE
DISINFECTING PROPERTIES OF CLEANING SOLUTIONS VARY;
CONSULT THE MANUFACTURER FOR SPECIFIC INFORMATION.
BATTERY MAINTENANCE
CAUTION: DO NOT OPERATE THE PUMP ON PATIENTS WITH
THE BATTERY REMOVED. USE OF A PROPERLY MAINTAINED
AND CH AR G ED B AT TER Y H ELPS CONF IR M PR OPER
OPERATION.
CAUTION:
CONNECT TO
I F THE LOW - BATTERY ALARM SOUNDS ,
AC (MAINS) POWER IMMEDIATELY.
The Plum A+ is battery powered for emergency backup and
temporary portable operation. A fully charged, new battery
provides six hours of operation at 125 mL/hr or 500 mL total
volume delivered, whichever occurs first.
System Operating Manual
8- 4
8) Cleaning, Maintenance, and Storage
NOTE: For optimum battery life, the Plum A+ should be
operated on battery power for six continuous hours at
least once every six months and then charged for a
minimum of six hours.
The battery charges whenever connected to AC (mains) power. If
the pump is switched OFF, recharge takes approximately six
hours. Recharge takes longer if the pump is turned ON.
As a general rule, the more often the battery is partially
discharged and recharged, the sooner it will need to be replaced.
Consult a qualified biomedical technician for battery replacement
if necessary.
To maintain maximum battery charge and to prolong battery life,
connect the pump to AC (mains) power whenever possible.
STORAGE
To prolong the life of the Plum A+, observe the following storage
precautions:
•
Store the away from excessive heat, cold, and
humidity
•
Store connected to AC (mains) power
•
Switch the pump OFF using the [ON/OFF] key
SERVICE
All servicing or adjustments to the Plum A+ should be referred to
qualified technical personnel. A technical service manual may be
ordered from the local Hospira sales office.
System Operating Manual
Plum A+ Infusion System
9)
9- 1
Specifications
PHYSICAL
Dimensions:
Approximately 8'' X 8'' X 6'', excluding pole
clamp protrusion and power cord storage.
Weight:
Approximately 9.5 lbs. with battery.
Casing:
High-impact plastic.
ELECTRICAL
Power
Requirements:
Fuses:
Power Cord:
Battery:
Battery Life:
Recharge:
Electrical Leakage:
100-120V, 50-60 Hz, 50 VA
Internal and non-replaceable
Hospital-grade AC cord. 10 ft long, with
transparent plug and retainer plate.
One sealed, lead-acid, rechargeable 6 V
battery, internal to device.
With a new fully charged battery, the infuser
operates for a minimum of six hours at 125 mL/
hr or less, or delivers 500 mL at 126 mL/hr or
greater on one line.
The batteries charge whenever the pump(s) is
connected to AC power. The recharge time is
approximately six hours with the device
operating at 125 mL/hr on one line.
Meets ANSI/AAMI ES1-1993 standard: Safe
Current Limits for Electro-medical Apparatus
System Operating Manual
9- 2
9) Specifications
NURSE-CALL
System:
NURSE-CALL alarm is factory set for NormallyOpen (NO)
Contact the Technical Services Center to make
an internal adjustment to change the device
from Normally-Open (NO) to Normally Closed
(NC) system.
Circuitry Ratings:
Voltage-30 VDC Max
Current- 0.25 Amps Max
Contact Rating- 3 Watts Max
VTBI RANGE
VTBI Range:
0.1 to 99.9 mL (in 0.1 mL increments)
100 to 9999 mL (in 1 mL increments)
ENVIRONMENT
Operating
Temperature:
Storage Temperature:
Atmospheric
Pressure:
Relative Humidity:
5° to 40° C
-20° to 60° C
0 - 10,000 feet (0 - 3,000m) or equivalent
pressure
10 - 90% (40° C Max)
DELIVERY RATE RANGE
Lines A and B:
0.1 - 99.9 mL/hr (in 0.1 mL increments)
100 - 999 mL/hr (in 1 mL increments)
Concurrent Delivery:
PlumSet:
KVO:
0.5 mL/hr minimum for each line
500 mL/hr cumulative (A+B) maximum
1.0 mL/hr or the last primary delivery rate,
whichever is less
System Operating Manual
Plum A+ Infusion System
9- 3
AIR-IN-LINE ALARM
PlumSet (Distal):
Bolus 0.1 mL or larger
Cumulative 0.25 mL out of 4.9 mL
PlumSet (Proximal):
Bolus at 0.5 mL, Total 1.0 mL
OCCLUSION ALARM AND LIMITS
Distal Occlusion:
The DISTAL OCCLUSION alarm sounds
after the distal set tubing or set outlet fitting
becomes occluded.
Proximal Occlusion:
The PROXIMAL OCCLUSION alarm
sounds if the tubing proximal to the
cassette becomes occluded.
Distal Pressure Limit
(without alarm):
1 to 15 psig. The maximum pressure is
user-selectable. Factory default setting is 6
psig.
Maximum Infusion
Pressure:
20 psig
TIME TO DETECT DOWNSTREAM OCCLUSIONS
OCCLUSION
ALARM
PRESSURE
SETTING
TYPICAL TIME
TO ALARM
(MACRO)
MAXIMUM TIME
TO ALARM
(MACRO)
25 mL/
hr
6 psig
38 seconds
47 seconds
15 psig
98 seconds
106 seconds
1 mL/hr
6 psig
17 minutes
22 minutes
15 psig
45 minutes
49 minutes
RATE
* Baseline backpressure is 0 psig *
System Operating Manual
9- 4
9) Specifications
BOLUS VOLUME RELEASED AFTER
DOWNSTREAM OCCLUSIONS ARE CORRECTED
OCCLUSION
ALARM
PRESSURE
SETTING
TYPICAL
BOLUS
VOLUME
(MACRO)
MAXIMUM BOLUS
VOLUME
(MACRO)
25 mL/
hr
6 psig
0.23 mL
0.28 mL
15 psig
0.55 mL
0.63 mL
1 mL/hr
6 psig
0.24 mL
0.30 mL
15 psig
0.59 mL
0.70 mL
RATE
* Baseline backpressure is 0 psig *
DELIVERY ACCURACY
The Plum A+ Infusion pump was designed and manufactured to
maintain a volumetric delivery rate error of the total fluid delivered
of less than or equal to ± 5% over the course of 48 hours at a
programmed rate of 1 to 999 mL/hr during normal operating
conditions. For use of the device at rates below 1 mL/hr, the
delivery rate error is less than or equal to ± 10%.
Backpressure Effect- Positive backpressure on the distal line may
affect delivery accuracy by no more than 0.5% per psig (2% per
psig for rates between 0.1 and 0.9 mL/hr) for backpressures up to
15 psig. A typical deviation under these conditions is 0.3%.
Negative backpressure may affect delivery accuracy no more than
2% for pressures up to -2 psig (56 inches of water). A typical
deviation under these conditions is 0.3%.
Filling Head Effect- Variations in filling head (such as container
height) may affect delivery accuracy by no more than 2% for
variations in the range -15 to +28 inches. A typical deviation under
these conditions is 0.5%.
Concurrent Delivery Effect- When both lines (A and B) are
delivering, the ratio of delivery for the fluid with the lowest rate may
be affected by as much as 5% for ratios up to 9 to 1. For higher
ratios, the absolute percentage of delivery for the lowest rate may
System Operating Manual
Plum A+ Infusion System
9- 5
be affected by no more than 0.5%. When air is present in the
bubble trap, the absolute percentage of delivery for the lowest rate
may be affected by up to 2.0%. When variations in container height
are present, the absolute percentage of delivery for the lowest rate
may be affected by up to 2.5% for up to 24 inches of container
height differences.
ENTERAL AND HIGH VISCOSITY FLUIDS
EFFECTS
System delivery accuracy limits for each Enteral and High Viscosity
Fluid, such as those listed in the following table, can be degraded
by an additional maximum of 5%. System accuracy for Enteral
Fluids is defined only for rates of 1 to 200 mL/hr, with no suspended
air in the solution, and using a Hospira Plum enteral set.
ENTERAL/HIGH VISCOSITY FLUIDS
Dextrose 20% to 50% concentration
IsomilTM Powder
SimilacTM Powder
Ensure PlusTM HN
TwoCalTM HN
JevityTM
System Operating Manual
9- 6
9) Specifications
TRUMPET CURVES
The Trumpet Curve Graphs following the Example show
representative maximum and minimum percent flow rate deviation
from the programmed rate over time. This information was
developed in accordance with IEC 60601-2-24: 1998, Sub-Clause
50.102. Refer to this standard for detailed information.
How to read a Trumpet Curve Graph (Refer to example on the
following page): The graphs following the Example plot flow rates at
30 second intervals for the first 2 hours and for the 96th hour of
delivery. The graph plots mean delivery rate error (Average of 3
pumps) for the 2nd hour and the 96th hour as a straight line. The
graph also presents maximum and minimum average delivery rate
error for this interval plotted by averaging delivery errors over
intervals of 2, 5, 11, 19 and 31 minutes (“Trumpet Curve”).
Note that at extremely low flow rates (that is, 0.1–0.3 mL/hr) and at
non-standard negative back pressures (-1 psi), the accuracy error
rate can be up to ±25%.
EXAMPLE
From the Trumpet Curve Graph sample that follows, find the 5
minute interval (A) at the horizontal axis and read the
corresponding points (B) and (C) on the vertical axis. The values
are approximately +2.8% and -0.5%.
This means that at the rate of 25 mL/hr the average maximum flow
rate fluctuation for any 5 minute time interval during the 2nd hour of
operation was within the limits of +2.8% and -0.5% from the
nominal rate. The average delivery rate error over the entire 2nd
hour was +1.6% (D).
System Operating Manual
Plum A+ Infusion System
9- 7
For other time intervals look at other points at the horizontal axis
and determine corresponding limits as above.
25 ML/HR, 0 mm Hg DELIVERY HEAD, START UP
A
PERCENT ERROR (%)
15.0%
10.0%
B
Max Positive Error over 5
Minute Interval = +2.8%
5.0%
+
+
0.0%
+
+
+
C Max Negative Error over 5
Minute Interval = -0.5%
-5.0%
-10.0%
D
Average Delivery
Rate Error = +1.6%
-15.0%
0
5
10
15
20
Observation Interval (minutes)
Max
+
Min
25
30
Mean
A trained professional can use the resulting graphs to select a pump
with the appropriate startup and flow characteristics to suit the
clinical application.
NOTE: As an example of how the trumpet curves can be
used, consider the maximum and minimum deviations at
the 5 minute average interval. The upper curve provides
the maximum expected delivery rate error over a 5
minute interval, the lower curve provides the minimum
expected delivery rate error over a 5 minute interval. An
example would be Dopamine administered at 5 µgm/kg/
min. At 5 minutes, the average drug delivery error would
be within the range of +2.8% and -0.5% of the expected
nominal rate.
System Operating Manual
9- 8
9) Specifications
25 ML/HR, 0 mm Hg DELIVERY HEAD, START UP
(Typical)
50
45
40
Rate (ml/hr)
35
30
25
20
15
10
5
0
-5
-10
0
10
20
30
40
50
60
70
80
90
100
110
120
Time (minutes)
Actual Rate
Programmed Rate
25 ML/HR, 0 mm Hg DELIVERY HEAD, START UP
(Typical)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
25
30
Observation Interval (minutes)
Max
Min
Mean
25 ML/HR, 0 mm Hg DELIVERY HEAD, START UP
(Composite of 3 Pumps)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
25
30
Observation Interval (minutes)
Max
Min
Mean
System Operating Manual
Plum A+ Infusion System
9- 9
25 ML/HR, 0 mm Hg DELIVERY HEAD , 96 HOURS
(Typical)
50
45
Rate (ml/hr)
40
35
30
25
20
15
10
5
0
0
10
20
30
40
50
Time (minutes)
Actual Rate
Programmed Rate
25 ML/HR, 0 mm Hg DELIVERY HEAD, 96 HOURS
(Typical)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
25
30
Observation Interval (minutes)
Max
Min
Mean
25 ML/HR, 0 mm Hg DELIVERY HEAD, 96 HOURS
(Composite of 3 Pumps)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
Observation Interval (minutes)
Max
System Operating Manual
Min
Mean
25
30
9- 10
9) Specifications
Rate (ml/hr)
1 ML/HR, 0 mm Hg DELIVERY HEAD, START UP
(Typical)
2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
-0.2
-0.4
0
10
20
30
40
50
60
70
80
90
100
110
120
Time (minutes)
Actual Rate
Programmed Rate
1 ML/HR, 0 mm Hg DELIVERY HEAD, START UP
(Typical)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
25
30
Observation Interval (minutes)
Max
Min
Mean
1 ML/HR, 0 mm Hg DELIVERY HEAD, STARTUP
(Composite of 3 Pumps)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
25
30
Observation Interval (minutes)
Max
Min
Mean
System Operating Manual
Plum A+ Infusion System
9- 11
Rate (ml/hr)
1 ML/HR, 0 mm Hg DELIVERY HEAD, 96 HOURS
(Typical)
2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
0
10
20
30
40
50
Time (minutes)
Actual Rate
Programmed Rate
1 ML/HR, 0 mm Hg DELIVERY HEAD, 96 HOURS
(Typical)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
25
30
Observation Interval (minutes)
Max
Min
Mean
1 ML/HR, 0 mm Hg DELIVERY HEAD, 96 HOURS
(Composite of 3 Pumps)
Percent Error (%)
15.0%
10.0%
5.0%
0.0%
-5.0%
-10.0%
-15.0%
0
5
10
15
20
Observation Interval (minutes)
Max
System Operating Manual
Min
Mean
25
30
9- 12
9) Specifications
NOTES
System Operating Manual
Plum A+ Infusion System
10- 1
10) Supplies and Accessories
10.1 Administration Fluids
ADMINISTRATION FLUIDS
•
All parenteral fluids
•
Whole blood
•
Blood fractions
ENTERAL AND HIGH VISCOSITY FLUIDS
•
Dextrose 20% to 50% concentration
•
Isomil Powder
•
Similac Powder
•
Ensure Plus HN
•
TwoCal HN
•
Packed red cells
CONTAINERS
•
Dual Chamber Parenteral flexible container
(NutrimixTM)
•
Large Volume Parenteral flexible plastic containers,
including premixed
•
Large Volume Parenteral glass containers, including
premixed and nutritional
•
Part Fill Parenteral flexible plastic containers,
including ADD-VantageTM
•
Part Fill Parenteral glass containers
•
Small Volume Parenterals
•
Syringes (may require special adapters)
•
Top Filled Enteral bags
•
Ready to hang Enteral solution containers
System Operating Manual
10- 2
10) Supplies and Accessories
10.2 Accessories
GENERAL
•
Syringe Adapter - List# 11986-48
•
Mini Pole - List# 12096-04-01
•
Secondary Container Support - List# 12095-03
•
Tandem Carrier - List# 12270-01
PC BASED APPLICATION
•
Hospira MedNet PC based software for Plum A+
Hospital Programmable Library Kit* List# 12679-04
•
*Junction Box to PC Cable - List # 11431-04
•
*Junction Box - List # 12074-04
•
Junction Box to Junction Box Cable List# 11431-04
* = included in MedNet Kit
NOTE: Contact Advanced Knowledge Center at 1-800241-4002 for latest listing of accessories.
System Operating Manual
Plum A+ Infusion System
11)
11- 1
Warranty
Subject to the terms and conditions herein, Hospira, Inc., herein
referred to as Hospira, warrants that (a) the product shall conform
to Hospira's standard specifications and be free from defects in
material and workmanship under normal use and service for a
period of one year after purchase, and (b) the replaceable battery
shall be free from defects in material and workmanship under
normal use and service for a period of 90 days after purchase.
Hospira makes no other warranties, express or implied, as to
merchantability, fitness for a particular purpose, or any other
matter.
Purchaser's exclusive remedy shall be, at Hospira's option, the
repair or replacement of the product. In no event shall Hospira's
liability arising out of any cause whatsoever (whether such cause
be based in contract, negligence, strict liability, other tort, or
otherwise) exceed the price of such product, and in no event shall
Hospira be liable for incidental, consequential, or special
damages or losses or for lost business, revenues, or profits.
Warranty product returned to Hospira must be properly packaged
and sent freight prepaid.
The foregoing warranty shall be void in the event the product has
been misused, damaged, altered, or used other than in
accordance with product manuals so as, in Hospira's judgment,
to affect its stability or reliability, or in the event the serial number
or lot number has been altered, effaced, or removed.
The foregoing warranty shall also be void in the event any
person, including the Purchaser, performs or attempts to perform
any major repair or other service on the product without having
been trained by an authorized representative of Hospira and
using Hospira documentation and approved spare parts. For
purposes of the preceding sentence, "major repair or other
service" means any repair or service other than the replacement
of accessory items such as batteries and detachable mains
power cords.
System Operating Manual
11- 2
11) Warranty
In providing any parts for repair or service of the product, Hospira
shall have no responsibility or liability for the actions or inactions
of the person performing such repair or service, regardless of
whether such person has been trained to perform such repair or
service. It is understood and acknowledged that any person other
than a Hospira representative performing repair or service is not
an authorized agent of Hospira.
System Operating Manual
Plum A+ Infusion System
12)
12- 1
Default Drug Library
NOTE: This list is only accurate if no custom drug library
has been developed using the Hospira MedNet
accessory. Once a custom drug library has been
developed, this list will no longer be accessible. Only
Hospira personnel can re-install the DDL.
Use drug manufacturer recommendations for IV
administration when using the Plum A+ infusion pump.
DRUG NAME
DEFAULT DOSE
RATE
No Drug Selected
mL/hr
Abciximab
mcg/kg/min
Acyclovir
mL/hr
N/A
Albumin
mL/hr
N/A
Aldesleukin
mL/hr
N/A
Alfentanil
mcg/kg/min
mcg/mL
Alteplase (rt-PA)
mg/kg/hr
mg/mL
Amikacin
mL/hr
Aminophylline
mg/hr
mg/mL
Amiodarone
mg/min
mg/mL
Amphotericin B
mL/hr
N/A
Ampicillin
mL/hr
N/A
Atracurium
mL/hr
N/A
Azithromycin
mL/hr
N/A
Bleomycin
mL/hr
N/A
Blood Products
mL/hr
N/A
Bretylium
mg/min
Carboplatin
mL/hr
N/A
Cefazolin
mL/hr
N/A
System Operating Manual
DEFAULT
CONCENTRATION
N/A
mg/mL
N/A
mg/mL
12- 2
12) Default Drug Library
DRUG NAME
DEFAULT DOSE
RATE
DEFAULT
CONCENTRATION
Cefepime
mL/hr
N/A
CefoPERAZONE
mL/hr
N/A
CefoTAXIME
mL/hr
N/A
CefoTETAN
mL/hr
N/A
CefoXITIN
mL/hr
N/A
CeftAZIDime
mL/hr
N/A
CeftIZOXime
mL/hr
N/A
Ceftriaxone
mL/hr
N/A
Cefuroxime
mL/hr
N/A
Cimetidine
mL/hr
N/A
Ciprofloxacin
mL/hr
N/A
Cisplatin
mL/hr
N/A
Clindamycin
mL/hr
N/A
Cotrimoxazole
mL/hr
N/A
Cytarabine
mL/hr
N/A
Diltiazem
mg/hr
mg/mL
DOBUTamine
mcg/kg/min
mg/mL
Docetaxel
mL/hr
DOPamine
mcg/kg/min
DOXOrubicin
mL/hr
Epinephrine
mcg/min
mg/mL
Epoprostenol
ng/kg/min
mg/mL
Eptifibatide
mcg/kg/min
mg/mL
Erythromycin
mL/hr
Esmolol
mcg/kg/min
Etoposide
mL/hr
N/A
Famotidine
mL/hr
N/A
Fentanyl
mL/hr
N/A
N/A
mg/mL
N/A
N/A
mg/mL
System Operating Manual
Plum A+ Infusion System
12- 3
DRUG NAME
DEFAULT DOSE
RATE
Fluconazole
mL/hr
N/A
Flumazenil
mL/hr
N/A
Fluorouracil
mL/hr
N/A
Furosemide
mL/hr
N/A
Gatifloxacin
mL/hr
N/A
Gentamicin
mL/hr
N/A
Heparin
units/kg/hr
Hydromorphone
mL/hr
N/A
Ifosfamide
mL/hr
N/A
Insulin
units/hr
units/mL
Labetalol
mg/min
mg/mL
Lepirudin
mg/kg/hr
mg/mL
Leucovorin
mL/hr
N/A
Levofloxacin
mL/hr
N/A
Lidocaine
mg/min
Lorazepam
mL/hr
Magnesium
grams/hr
grams/mL
Mannitol
grams/hr
grams/mL
Mesna
mL/hr
N/A
MethoHEXITAL
mL/hr
N/A
MethoTREXATE
mL/hr
N/A
Metoclopramide
mL/hr
N/A
Metronidazole
mL/hr
N/A
Midazolam
mL/hr
N/A
Milrinone
mcg/kg/min
mg/mL
Morphine
mg/hr
mg/mL
Nafcillin
mL/hr
NitroGLYCERIN
mcg/min
System Operating Manual
DEFAULT
CONCENTRATION
units/mL
grams/mL
N/A
N/A
mg/mL
12- 4
12) Default Drug Library
DRUG NAME
DEFAULT DOSE
RATE
DEFAULT
CONCENTRATION
NitroPRUSSIDE
mcg/kg/min
mg/mL
Norepinephrine
mcg/min
mg/mL
Ofloxacin
mL/hr
N/A
Ondansetron
mL/hr
N/A
Oxacillin
mL/hr
N/A
Oxytocin
mUn/min
Paclitaxel
mL/hr
Pantoprazole
mg/min
Penicillin
mL/hr
N/A
Pentobarbital
mL/hr
N/A
Phenylephrine
mcg/min
Piperacillin
mL/hr
Potassium
mEq/hr
mEq/mL
Procainamide
mg/min
grams/mL
Propofol
mcg/kg/min
mg/mL
Ranitidine
mL/hr
STREPTOkinase
units/hr
units/mL
Theophylline
mg/kg/hr
mg/mL
Ticar-clavulanate
mL/hr
Tirofiban
mcg/kg/min
Tobramycin
mL/hr
N/A
UROkinase
mL/hr
N/A
Vancomycin
mL/hr
N/A
Verapamil
mL/hr
N/A
VinCRIStine
mL/hr
N/A
units/mL
N/A
mg/mL
mg/mL
N/A
N/A
N/A
mg/mL
System Operating Manual
Plum A+ Infusion System
For customer service within the United States, contact:
1-877-9-HOSPIRA (1-877-946-7747)
For technical assistance, product return authorization, and to
order parts, accessories, or manuals within the United States,
contact Hospira, Inc. Advanced Knowledge Center:
1-800-241-4002
To order parts using the online eCatalog, download technical
publications, technical training courses, and additional
services, visit the website at:
www.hospiraparts.com
Outside the U.S., contact your local Hospira, Inc. sales office.
CAUTION: FEDERAL (USA) LAW RESTRICTS THIS
INFUSER TO SALE BY OR ON THE ORDER OF A PHYSICIAN
OR OTHER LICENSED PRACTITIONER.
WARNING
POSSIBLE EXPLOSION HAZARD EXISTS IF THE
INFUSER IS USED IN THE PRESENCE OF
FLAMMABLE ANESTHETICS.
Type CF
Class 1
Per IEC 60601-1 F-Type
Applied Part complying
with the highest degree of
protection against electric
shock. Type CF Applied
Parts are those parts
suitable for direct cardiac
application.
Fragile, Handle with
Care
Protection against
vertically falling water
drops.l
Keep Dry
Mains supply equipment
using protective earth.
Attention: Consult
Accompanying
Documents
or
Caution
The ‘C’ and ‘US’ indicators
adjacent to the CSA Mark
signify that the product
has been evaluated to the
applicable CSA and ANSI/
UL Standards, for use in
Canada and the U.S.,
respectively. This ‘US’
indicator includes
products eligible to bear
the ‘NRTL’ indicator.
NRTL, i.e., National
Recognized Testing
Laboratory, is a
designation granted by
the U.S. Occupational
Safety and Health
Administration (OSHA) to
laboratories which have
been recognized to
perform certification to
U.S. Standards.
Temperature
Limitation
This Way Up
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