Covidien Puritan Bennett 520 Clinician Manual
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Clinician's Manual
Puritan Bennett
TM
520 Ventilator
Copyright information
COVIDIEN, COVIDIEN with logo, the Covidien logo and positive results for life are U.S. and internationally registered trademarks of
Covidien AG.All other brands are trademarks of a Covidien company.
© 2012, 2015, 2017 Covidien.
The information contained in this manual is the sole property of Covidien and may not be duplicated without permission. This manual may be revised or replaced by Covidien at any time and without notice. You should ensure that you have the most current applicable version of this manual; if in doubt, contact Covidien's Technical Support department or visit the product manual web page at: www.medtronic.com/covidien/support/product-manuals
While the information set forth herein is believed to be accurate, it is not a substitute for the exercise of professional judgment.
The ventilator should be operated and serviced only by trained professionals. Covidien’s sole responsibility with respect to the ventilator, and its use, is as stated in the limited warranty provided.
Nothing in this manual shall limit or restrict in any way Covidien’s right to revise or otherwise change or modify the equipment
(including its software) described herein, without notice. In the absence of an express, written agreement to the contrary, Covidien has no obligation to furnish any such revisions, changes, or modifications to the owner or user of the equipment (including its software) described herein.
Table of Contents
Clinician’s Manual iii
iv
Clinician’s Manual
Table of Contents
Clinician’s Manual v
vi
Recommended Schedule of Maintenance
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2
Clinician’s Manual
Table of Contents
Operational Verification Checklist
Clinician’s Manual vii
Page Left Intentionally Blank viii
List of Figures
Clinician’s Manual ix
x
Clinician’s Manual
List of Figures
Clinician’s Manual xi
Page Left Intentionally Blank xii
List of Tables
Clinician’s Manual xiii
xiv Clinician’s Manual
Preface
Purpose of this Manual
This manual contains important information regarding the safe operation of your Puritan Bennett™ 520 Ventilator. Your ventilator is an electrical device that can provide years of useful service with the proper care, as described in this manual.
Ensure that you read and understand the instructions contained in this manual before operating the ventilator.
WARNING:
Before operating the ventilator, read, understand, and strictly follow the information contained in Chapter
. “
Qualification of Personnel
Installation and maintenance of the device must be made by authorized and trained personnel.
In particular, training for the handling of products sensitive to electrostatic discharges must include the use of electrostatic discharge (ESD) protection devices and knowledge of the following symbol’s meaning: , as well as using original spare parts and respecting quality assurance and traceability rules approved by Covidien.
Warranty
Information regarding your product warranty is available from your sales representative or Covidien.
Extended Service
The Puritan Bennett 520 Ventilator offers extended service contracts/warranties for purchase when the ventilator is purchased. Please contact your local Covidien sales or service representative for additional information.
xv
Preface
For online technical support, visit the SolvIT
SM
Center Knowledge Base by clicking the link at: www.medtronic.com/covidien/support/solvit-centerknowledge-base/.
Here, you will find answers to frequently asked questions about the product and other Covidien products 24 hours a day, 7 days a week. If you require further assistance, contact your local Covidien representative.
Technical Support
Covidien Argentina
Vedia 3616
Buenos Aires
Argentina
Tel: 5411 4863 5300
Fax: 5411 4863 4142
Covidien Belgie S.A.-N.V.
Generaal De Wittelaan 9/5
Mechelen
2800
België
Tel: +32 220 08260
Fax: +32 270 06690
Covidien Chile
Lo Boza 107
Pudahuel
Santiago de Chile, Chile
Tel: 562 2739 3000
Fax: 562 231 3527
Covidien ECE s.r.o. organizační složka
Prosek, Prosecká 852/66
190 00 Praha 9
Tel: +420 241 095 735
Fax: +420 239 016 856
Technical service contacts:
Covidien Australia
52A Huntingwood Drive
Huntingwood, NSW 2148
Australia
Tel: +61 1800 350702
Fax: +612 9671 8118
Covidien Brazil
Praça Agrícola La Paz Tristante, 121
Osasco – São Paulo / CEP 06276-035
São Paulo, SP
Brasil
Tel: +55 11 2187 6543
Fax: 5511 2187 6380
Covidien Austria GmbH
Campus21
Europaring F09402
Brunn am Gebrige
A-2345 Österreich
Tel: +43 1 20609 1143
Fax: +43 1 20609 2457
Covidien Canada
19600 Clark Graham
Baie d'Urfe, QC, H9X 3R8
Canada
Tel: 1 877 664 8926 (option 2)
Fax: 1 514 695 7534
Covidien Colombia
Edificio Prados de la Morea
Carretera Central Del Norte
(Cra 7a) Kilometro 18,
Chia-Cundinamarca
Bogota, Colombia
Tel: 571 668 3777
Fax: 571 668 3777 ext. 181
Covidien Danmark A/S
Langebrogade 6E, 4. sal
1411 København K
Danmark
Tel: +45 43 68 21 71
Fax: +45 43 31 48 99
Covidien Costa Rica
Global Park, Parkway 50
La Aurora, Heredia, 40104
Costa Rica
Tel: 506 2293 4854
Fax: 506 2239 9108
Covidien Deutschland GmbH
Technisches Service Center
Raffineriestr. 18
93333 Neustadt / Donau
Germany
Tel: + 49 69 51 709670
Fax: + 49 69 29 9571608 xvi Clinician's Manual
Clinician's Manual
Technical Support
Covidien ECE
Galvaniho 7/a
821 04 Bratislava
Slovenska Republika
Tel: +42 124 821 45 73
Fax: +42 124 821 45 01
Covidien Italia S.p.A.
Via S.Bovio 3
San Felice, 20090 Segrate (MI) Italy
Italy
Tel: +39 02 91483320 (option 3)
Fax: +39 02 91294863
Covidien Nederland BV
Hogeweg 105
5301 LL Zaltbommel
Nederland
Tel: +31 202061470
Fax: +31 707 709229
Covidien Polska
Al. Jerozolimskie 182
Warszawa. 02-222
Polska
Tel: +48 22 279 04 05
Fax: +48 22 279 04 03
Covidien Russia
53 bld. 5 Dubininskaya Street
Moscow
Russia 119054 России
Tel: +70 495 933 64 69
Fax: +70 495 933 64 68
Technical service contacts:
Covidien Finland Oy
Rahtitie 3
FI-01530 Vantaa
Finland
Tel: +358 9 725 192 88
Fax: +358 9 725 192 89
Covidien Japan Inc.
Technical Support Center
83-1, Takashimadaira 1-Chome
Itabashi-ku, Tokyo 175-0082 Japan
Tel: +81 0 3 6859 0120
Fax: +81 0 3 6859 0142
Covidien France SA
Parc d’affaires Technopolis
Bat. Sigma, 3 Avenue du Canada
LP 851 Les Ulis
91975 Courtaboeuf Cedex France
Tel: +33 1 57 32 35 10
Fax: +33 1 57 32 70 10
Covidien Mexico
Av. Insurgentes Sur 863, Pisos 15 y 16
Col. Nápoles
Del. Benito Juárez
México, D.F. 03810 México
Tel: 5255 5804 1524
Fax: 5255 5536 1326
Covidien Norge AS
Postboks 343
1372 Asker.
Norway
Tel: +472415 9887
Fax: +47 2302 4955
Covidien Panama
Parque Industrial Costa del Esta
Calle Primera, Edifio # 109
Panama City, Panama
Tel: 507 264 7337
Fax: 507 236 7408
Covidien Portugal Lda.
Estrada do Outeiro de Polima, Lote 10-
1° Abóboda
2785-521 S. Domingos de Rana
Portugal
Tel: +351 21 761 62 44
Fax: +351 800 781385
Covidien Puerto Rico
Palmas Industrial Park
Road 869 Km 2.0 Bdlg. #1
Cataño, PR 00962
Tel. 787 993 7250 ext. 7222 or 7221
Fax: 787 993 7234
Covidien Saglik A.S.
Maslak Mahallesi Bilim Sokak No: 5,
Sun Plaza Kat: 2-3
Sisli, Istanbul 34398
Turkey
Tel: +90 212 366 20 00
Fax: +90 212 276 35 25
Covidien South Africa
Corporate Park North
379 Roan Crescent
Randjespark
Midrand, South Africa
Tel: +27 115 429 500
Fax: +27 115 429 547
xvii
Preface
Covidien Spain S.L.
Servicio Técnico
WTC Almeda Park
Plaça de la Pau, S/N - Edif. 7, 3ª Planta
08940 Cornellá de Llobregat
Barcelona, Spain
Tel: +34 91 275 48 54 (option 3)
Fax: +34 91 276 89 33
Covidien UK and Ireland
Unit 2, Talisman Business Park
London Road, Bicester
OX26 6HR, United Kingdom
Tel: +44 20 3027 1757
Fax: +44 20 3684 8869
Technical service contacts:
Covidien Sverige AB
Box 54
171 74 Solna
Sweden
Tel: +46 8 517 615 73
Fax: + 46 8 502 521 10
Asia: Tyco Healthcare Pte Ltd
Singapore Regional Service Centre
15 Pioneer Hub, #06-04
Singapore 627753
Tel: 65 6578 5187 / 8 / 9
Fax: 65 6515 5260
Email: [email protected]
Covidien Switzerland
Roosstr. 53
Wollerau
8832
Schweiz
Tel: +41 44 511 82 71
Fax: +41 44 511 16 34 xviii Clinician's Manual
1 Safety Information
1.1
Definitions
This manual uses three indicators to highlight critical information: warning, caution, and note.
They are defined as follows:
WARNING
Indicates a condition that can endanger the patient or the ventilator operator.
Caution
Indicates a condition that can damage the equipment.
Note
Indicates points of particular emphasis, that make operation of the ventilator more efficient or convenient.
It is essential to read, understand and follow these instructions before using the Puritan Bennett™ 520 Ventilator.
In order to use the ventilator correctly and efficiently and to help prevent incidents, please pay particular attention to section
,” as well as all warnings and cautions contained throughout this manual.
1.2
Warnings
1.2.1
Fire Hazard Warnings
WARNING:
The ventilator must not be used with flammable anesthetic substances.
WARNING:
To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses.
1-1
1-2
Safety Information
WARNING:
Never expose any batteries to direct flame.
WARNING:
In the event of an oxygen leak, shut down the supply of oxygen at its source. In addition, remove and/or keep any incandescent source away from the device, which may be enriched with oxygen.
Circulate fresh air into the room to reduce the oxygen concentration level.
1.2.2
Warnings About Reducing Infection
WARNING:
To reduce the risk of infection, wash your hands thoroughly before and after handling the ventilator or its accessories.
WARNING:
A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection.
WARNING:
Single Use accessories should not be reused.
WARNING:
The air inlet filter is for use on a single patient and is not reusable; do not attempt to wash, clean, or reuse it.
1.2.3
Warnings Before Using Equipment
WARNING:
The ventilator must be used only under the responsibility and on the prescription of a doctor.
WARNING:
The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent.
WARNING:
The ventilator must be used according to its intended use. Refer to
.”
Clinician's Manual
Warnings
WARNING:
Do not start ventilation until you ensure that the device is suitably assembled, that the air inlet filter is properly installed and is not obstructed, and that there is proper clearance all around the unit. Also ensure that the patient circuit is suitably connected to both the ventilator and the patient and that the patient circuit, including all hoses, is not damaged or obstructed.
WARNING:
Before dispensing the ventilator to caregivers or the patient for home use, ensure the Locking Key is activated so that critical ventilator settings are not modified.
WARNING:
Do not perform ventilator alarm tests while the patient is connected to the ventilator. Provide the patient with an alternate means of ventilation before conducting these tests.
WARNING:
Verify the functionality of the alarm conditions before connecting the patient to the ventilator.
Refer to Appendix F , “ Alarms Tests .”
WARNING:
If the ventilator fails the alarm tests or if you cannot complete the tests, refer to section 5.8
,
“ Troubleshooting ” or call your equipment supplier or Covidien.
WARNING:
The default setting for altitude compensation is YES. Altitude compensation should always be set to YES for accurate volume delivery calculations at all elevations.
WARNING:
Before starting ventilation, ensure that the device is properly assembled and that the air inlet, cooling vents, and alarm sound diffusion holes are not obstructed. Ensure also that the patient circuit is of the proper configuration, properly connected to the ventilator, and that the circuit hoses are neither damaged nor compressed and contain no obstructions or foreign bodies.
WARNING:
This ventilator offers a choice of breath delivery modes and types. Throughout the patient’s treatment, the clinician should carefully select the ventilation mode and/or breath type to use for that patient. This selection should be based on the clinician’s clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time, and considering the benefits, limitations and operating characteristics of each mode and/or breath type.
WARNING:
Patients on home care ventilation equipment should be appropriately monitored by clinicians, caregivers and suitable monitoring equipment, as advised by the patient’s clinician. The Puritan
Clinician's Manual 1-3
1-4
Safety Information
Bennett™ 520 Ventilator is not intended to be a comprehensive monitoring device and does not activate alarms for all types of dangerous conditions for patients.
1.2.4
Warnings Regarding Environment of Use
WARNING:
Do not operate the ventilator in direct sunlight, near heat sources, outdoors, or near installations where liquid may pose a risk without first providing adequate protection for the device.
WARNING:
Avoid using the ventilator, if possible, in dusty environments. Dusty environments may require more vigilant monitoring, cleaning, and/or replacement of air intake and other filters.
WARNING:
Ensure that the ventilator’s immediate surroundings allow for the proper operational connection of the device without folding, pinching, or damaging any of the required cables or tubes, and that the connection of the patient circuit to the patient provides for a secure, comfortable fit.
WARNING:
Place the ventilator in a safe place when ventilating and according to the recommendations in this manual.
WARNING:
Do not place the ventilator in a position where a child can reach it or in any position that might cause it to fall on the patient or someone else.
WARNING:
To ensure correct and lasting operation of the ventilator, ensure that its air circulation holes (main inlet or cooling) are never obstructed. Place the device in an area where air can freely circulate around the ventilator and avoid installing it near floating fabrics, such as curtains.
WARNING:
If the ventilator has been transported or stored at a temperature that differs more than
20°C (
68°F) from the temperature in which it will be operating, the ventilator should be allowed to stabilize in its operating environment for at least two (2) hours prior to use.
WARNING:
If the ambient temperature where the device is operated is greater than 35°C (95°F), the flow supplied at the device outlet may exceed 41°C (106°F). This may lead to undesirable side effects for the patient. To avoid injury to the patient move the patient and the ventilator to a cooler location.
Clinician's Manual
Warnings
WARNING:
The default setting for altitude compensation is YES. Altitude compensation should always be set to YES for accurate volume delivery calculations at all elevations.
WARNING:
To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses.
WARNING:
Before starting ventilation, ensure that the device is properly assembled and that the air inlet, cooling vents, and alarm sound diffusion holes are not obstructed. Ensure also that the patient circuit is of the proper configuration, properly connected to the ventilator, and that the circuit hoses are neither damaged nor compressed and contain no obstructions or foreign bodies.
WARNING:
Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If
necessary, replace the filter before the recommended replacement period is over (see Chapter 10
,
“ Routine Maintenance ”). This is particularly important when the ventilator is installed on a
wheelchair, because environmental conditions may cause the filter to become dirty more rapidly.
WARNING:
Due to typical voltage fluctuations that occur during normal power wheelchair use, the wheelchair mains battery should never be used to power the Puritan Bennett™ 520 Ventilator. The ventilator should always be connected to an independent power source (e.g., AC power, extra batteries, or
DC power source).
WARNING:
Handle the ventilator with care during and after use, particularly when ambient temperatures are high. Some ventilator surfaces may become hot, even if safety specifications are not exceeded.
WARNING:
Alarm volume should be adjusted with respect to the ventilator’s operating environment and so that the patient's caretakers can hear the alarms. See
.” The audible alarm vents located at the front of the device should never be obstructed.
1.2.5
Warnings Regarding Electromagnetic Interference
WARNING:
The Puritan Bennett™ 520 ventilator requires special precautions for electromagnetic compatibility and should be installed and started according to the recommendations found in
Appendix B , “ Specifications .” In particular, the use of nearby mobile and portable communications
Clinician's Manual 1-5
1-6
Safety Information equipment using radio frequencies, such as mobile telephones or other systems exceeding the
levels set in the IEC 60601-1-2 standard, may affect its operation. Refer to section B.10
“ Manufacturer’s Declaration .”
WARNING:
The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation.
1.2.6
Warnings Regarding Settings
WARNING:
Before starting ventilation, always verify that all settings are properly set in accordance with the required prescription.
WARNING:
The Puritan Bennett™ 520 Ventilator offers a variety of breath delivery modes. Throughout the patient’s treatment, the clinician should carefully select the ventilation mode or modes to use for that patient. This selection should be based on the clinician's clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time, and considering the benefits, limitations and operating characteristics of each mode.
WARNING:
The CPAP mode does not provide a set respiratory rate. Do not use this mode if it is not appropriate for the patient’s condition.
WARNING:
Alarm volume should be adjusted with respect to the ventilator’s operating environment and so
that the patient's caretakers can hear the alarms. See 7.3.4
.”
WARNING:
Ensure that the I Sens setting is not set to OFF when ventilating patients capable of triggering spontaneous breaths.
WARNING:
Monitor the patient's state of health in order to ensure that the ventilator’s settings are always suited to the patient’s current physiological requirements.
Clinician's Manual
Warnings
WARNING:
In adult or pediatric use ensure that the adjusted tidal volume is compatible with the needs of the patient.
WARNING:
When changing the mode during ventilation, significant transitions of pressure, flow or cycling rate might occur, depending on the difference between the modes. Before setting the new mode, first ensure that the settings between the different modes are compatible. This reduces the risk of discomfort and harm to the patient.
WARNING:
The setting of the Min PIP alarm must be adjusted for the patient, but must also be set high enough to allow the PATIENT DISCONNECTION alarm to trigger properly. Perform the Low Pressure Test
”) to ensure the Min PIP alarm is properly set.
WARNING:
If APNEA TIME is set to a value higher than 60/Control R then the APNEA alarm will not activate.
WARNING:
The Apnea Alarm should be set to YES if an audible alarm sound is desired when apnea events occur.
WARNING:
Setting Alarm limits to extreme values can cause the ventilator alarms to malfunction.
WARNING:
Ensure the I Time setting is compatible with the physiological requirements of the patient.
WARNING:
Adjustable alarms should not be systematically canceled; instead, they should be adjusted according to the needs and condition of the patient.
WARNING:
The inspiration trigger threshold should be carefully modified in order to avoid the risk of false triggering or “autotriggering” of the ventilator. For example, Level 0P, the most sensitive mode, is recommended for pediatric use. However, for an adult, this setting may result in autotriggering.
Clinician's Manual 1-7
1-8
Safety Information
1.2.7
Warnings Applicable During Use of Equipment
WARNING:
The ventilator must be used only under the responsibility and on the prescription of a doctor.
WARNING:
The ventilator must be used according to its intended use. Refer to section
WARNING:
The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent.
WARNING:
Be aware this manual describes how to respond to the ventilator, but it does NOT tell you how to respond to the patient.
WARNING:
While the ventilator is in use, an alternative means of ventilation should always be available in the event of a ventilator problem. Supplementary observation, appropriate for the patient's condition, is also recommended.
WARNING:
Patients should always be monitored by trained and competent medical personnel. Ensure that the patient’s caregiver is able and prepared to take suitable action in the event the ventilator identifies an alarm condition or experiences a problem.
WARNING:
When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator.
WARNING:
A continuous alarm condition will be activated if the ventilator power switch is turned off while ventilation is in progress. When the power switch is turned back on again, ventilation will resume without having to press the VENTILATION ON/OFF button.
WARNING:
If the device is damaged, its external housing is not correctly closed, or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odor, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately.
Clinician's Manual
Warnings
WARNING:
Handle the ventilator with care during and after use, particularly when ambient temperatures are high. Some ventilator surfaces may become hot, even if safety specifications are not exceeded.
WARNING:
Even though the Puritan Bennett™ 520 Ventilator meets current safety standards, and although the internal Lithium-ion battery of the device is considered to be Dangerous Goods for transport in commerce, this devices lithium battery is below the 100Wh threshold and is therefore excepted from being a Class 9 – Miscellaneous - Dangerous Goods (DG). As such, the Puritan Bennett™ 520
Ventilator and/or the associated Lithium-ion battery are subject to some transport conditions under the Dangerous Goods Regulation for air transport (IATA: International Air Transport
Association), International Maritime Dangerous Goods code for sea and the European Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) for Europe. Private individuals who transport the device are excluded from these regulations although for air transport some requirements apply. For air transport; the Puritan Bennett™ 520 Ventilator is permitted as checked-in or carry-on baggage. Spare batteries may be taken on board as carry-on luggage only. This classification and regulatory requirements may vary depending upon the country and mode of transport. Therefore it is recommended that users verify with the carrier / airline as to which measures to take before the voyage.
WARNING:
To minimize the risk of damage, you must use the ventilator’s Dual Bag to transport the ventilator.
See Table H-1. List of Consumables and Accessories .
WARNING:
To ensure that ventilation continues uninterrupted, ensure alternative power sources are available (AC power source, extra batteries, or an auxiliary DC car adapter). Be prepared for the possibility of power failure by having an alternative means of ventilation ready for use.
WARNING:
The ventilator must not be used with flammable anesthetic substances.
WARNING:
The ventilator should never be immersed in any liquid, and any liquid on the surface of the device should be wiped away immediately.
WARNING:
To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator.
Clinician's Manual 1-9
Safety Information
WARNING:
To ensure correct and lasting operation of the device, ensure that the ventilator is installed and operated in the environmental conditions recommended in Appendix
.”
WARNING:
Do not leave power cables lying on the ground where they may pose a hazard.
WARNING:
Do not allow a patient to remain connected to the ventilator when ventilation is stopped, because a substantial quantity of exhalation gas, primarily carbon dioxide, may be inhaled by the patient.
In some circumstances, inhaling carbon dioxide may lead to under ventilation, suffocation, and serious injury or death.
WARNING:
Do not conduct the ventilator alarm test while the patient is connected to the ventilator. Switch the patient to an alternate means of ventilation before testing.
1.2.8
Warnings Regarding Electrical Power
WARNING:
To ensure that ventilation continues uninterrupted, ensure alternative power sources are available (AC power source, extra batteries, or an auxiliary DC car adapter). Be prepared for the possibility of power failure by having an alternative means of ventilation ready for use.
WARNING:
Never connect your ventilator to an electrical outlet controlled by a wall switch because the power may be inadvertently turned off.
WARNING:
To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator.
WARNING:
Do not leave power cables lying on the ground where they may pose a hazard.
WARNING:
Due to typical voltage fluctuations that occur during normal power wheelchair use, the wheelchair mains battery should never be used to power the Puritan Bennett™ 520 Ventilator. The ventilator should always be connected to an independent power source (e.g., AC power, extra batteries, or
DC power source).
1-10 Clinician's Manual
Warnings
WARNING:
The operator should connect the ventilator to an AC power source whenever available, for safer operation.
WARNING:
The maximum recommended shelf life of the internal battery is two (2) years. Do not use a battery that has been stored for two years, or more, prior to its first use.
WARNING:
Periodic recharging is important to help maximize useful life of the battery. Do not store the internal battery for extended periods, without recharging, as this may reduce the maximum life.
WARNING:
For the AC (“mains”) power cable to be properly secured, the attachment located on the power cable must be fitted into the power cable holder incorporated in the battery access cover and located under the AC (mains) power socket. Refer to section
, “ Connecting to External AC Power .”
WARNING:
The power supply to which the ventilator is connected (both AC and DC) must comply with all applicable standards and provide electrical power corresponding to the voltage characteristics inscribed on the rear of the ventilator to ensure correct operation. Refer also to the electrical
specifications found in Appendix B
, “
WARNING:
Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12– 30 VDC power source (via the DC power cable) does not enable its internal battery to recharge.
WARNING:
Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged.
WARNING:
When using a car auxiliary adapter (cigarette lighter) ensure the car has been started prior to plugging in the ventilator’s DC adapter. Refer to section
, “ Connecting to an External DC Power
.”
WARNING:
Even if the “INTERNAL BATTERY” charging indicator is off, charging of the battery may sometimes be incomplete if the ambient temperature is above 40 °C (104 °F) because of the battery’s internal heat safety device.
Clinician's Manual 1-11
Safety Information
WARNING:
When the “LOW BATTERY“ alarm is triggered, immediately connect the ventilator to an AC power supply to maintain ventilation and recharge the internal battery.
WARNING:
Batteries should be disposed of according to environmental legislation in your country and locality.
WARNING:
Ensure that the AC power cable is in perfect condition and not compressed. The device should not be turned on if the AC power cable is damaged.
WARNING:
A continuous alarm condition will be activated if the ventilator power switch is turned off while ventilation is in progress. When the power switch is turned back on again, the ventilation will resume without having to press the VENTILATION ON/OFF button.
WARNING:
Before using the ventilator’s internal battery, ensure that the battery is fully charged and that the charge holds. Back up ventilators or those in storage should be connected to an AC power source to protect the integrity of the battery.
WARNING:
To connect the ventilator to an external power source, first connect the desired power cable to the ventilator. Then connect the power cable to the external power source.
WARNING:
To disconnect the ventilator from an external power source, first disconnect the power cable from the external power source and then, the ventilator.
WARNING:
Connect the external DC power source by first connecting the power cable to the ventilator and then to the external DC source. Follow the reverse procedure to disconnect the device from the external DC power source.
1.2.9
Warnings Regarding Oxygen
WARNING:
Oxygen therapy for patients with respiratory failure is a common and effective medical prescription. However, be aware that inappropriate oxygen use may potentially lead to serious complications, including, but not limited to, patient injury.
1-12 Clinician's Manual
Warnings
WARNING:
Strictly follow the instructions provided in section 6.7.2
, “ Connecting the Oxygen Supply
,” which include the use of a special oxygen connector.
WARNING:
To avoid injury to the patient and/or possible damage to the ventilator: before connecting the ventilator to the oxygen supply, ensure a flow meter (flow regulator) is connected to the ventilator to regulate the oxygen supply to the required specification.
WARNING:
If using oxygen with the Puritan Bennett™ 520 Ventilator, Covidien recommends using an oxygen analyzer with minimum and maximum concentration alarms. Always measure the delivered oxygen with a calibrated oxygen analyzer that features a minimum and maximum concentration alarm in order to ensure that the prescribed oxygen concentration is delivered to the patient.
WARNING:
The Puritan Bennett™ 520 Ventilator is designed to deliver a percentage of oxygen equal to or lower than 50%. Do not exceed this value as this may cause the ventilator to malfunction and put the patient at risk.
WARNING:
Ensure that the oxygen supply pressure to the machine never exceeds 7 psi (50 kPa) or a flow of 15
lpm. Refer to Table B-8. on page B-3
for sensitivity tolerances.
WARNING:
In the event of an oxygen leak, shut down the supply of oxygen at its source. In addition, remove and/or keep any incandescent source away from the device, which may be enriched with oxygen.
Circulate fresh air into the room to bring the oxygen level down to normal.
WARNING:
The hose connecting the ventilator to the oxygen source must be designed exclusively for use with medical-grade oxygen. Under no circumstances should the oxygen hose be modified by the user.
In addition, the hose must be installed without the use of lubricants.
WARNING:
Ensure that the only gas supplied to the ventilator through the dedicated oxygen supply connector is medical-grade oxygen.
WARNING:
The coupler must not remain connected to the oxygen connector unless it also connected to a leak-proof, external oxygen gas source. When an oxygen supply is not being used with the ventilator, disconnect the oxygen source completely from the ventilator.
Clinician's Manual 1-13
Safety Information
WARNING:
To ensure stability, when the Puritan Bennett™ 520 Ventilator is mounted on a cart, the weight of the oxygen bottle should not exceed 14 kg (30 lbs).
WARNING:
The oxygen supply hose ages even when it is not in use and should be replaced periodically.
Follow the expiration date, if any.
WARNING:
The oxygen supply must be regulated using a flow meter connected to the source gas outlet.
WARNING:
The oxygen supply must be shut off when ventilation is interrupted. Before disconnecting the oxygen hose, allow the ventilator to continue for a few cycles without oxygen to flush the patient circuit of excess oxygen.
WARNING:
Before connecting the oxygen supply, ensure that the stud on the oxygen connector is protruding outwards.
WARNING:
Inspect the oxygen coupler before use to ensure it has its black o-ring attached and in good condition. Do not use an oxygen coupler with a missing, damaged, or worn o-ring.
1.2.10
Warnings Regarding Hoses and Accessories
WARNING:
The ventilator must not use, nor be connected to, any anti-static or electrically conductive hoses, tubing, or conduits.
WARNING:
Before opening the packaging for the Patient Circuit, ensure that no damage is evident to the packaging or its contents. Do not use if evidence of damage exists.
WARNING:
The patient circuit should not be changed during ventilation.
WARNING:
On a DAILY basis, inspect the patient circuit to ensure that it shows no signs of damage, is properly connected, and is operating correctly without leakage.
1-14 Clinician's Manual
Warnings
WARNING:
Single Use accessories should not be reused.
WARNING:
During invasive ventilation (when an artificial airway bypasses the patient’s upper respiratory system), the patient’s upper respiratory system cannot humidify the incoming gas. For this reason, the use of a humidifier, to minimize drying of the patient’s airway and subsequent irritation and discomfort, is required.
WARNING:
The air inlet filter is for use on a single patient. It is not reusable; do not attempt to wash, clean, or reuse it.
WARNING:
Failing to replace a dirty air inlet filter, or operating the ventilator without a filter, may cause serious damage to the ventilator.
WARNING:
The patient circuit should always be positioned to avoid hindering the patient's movements, to prevent accidental disconnection or leakage, and to minimize the risk of patient strangulation.
WARNING:
For pediatric use, ensure that the patient circuit type fits, and, in all respects, is suitable for use with a child. Use a pediatric circuit for patients that weigh under 53 lb. (23 kg). To ensure proper performance of the ventilator, see
Table H-2. , List of Circuits , on page H-2 , for a list of
recommended patient circuits.
WARNING:
The exhalation valve must allow rapid discharge of the circuit pressure. Ensure that the exhalation valve is always clean and its evacuation aperture (exhaust port) is never obstructed.
WARNING:
Users must always possess an additional breathing circuit and exhalation valve while using the ventilator.
WARNING:
Always ensure that the humidification device is positioned lower than both the ventilator and the patient. Use water traps, if necessary, to limit water in the patient circuit and periodically empty these water traps.
Clinician's Manual 1-15
Safety Information
WARNING:
If a heated humidifier is used, you should always monitor the temperature of the gas delivered to the patient. Gas delivered from the ventilator that becomes too hot may burn the patient's airway.
WARNING:
Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration.
WARNING:
The level of inspiratory resistance of the circuit and accessories (bacteria filter, humidifier, HMEs, etc.) must be as low as possible. Settings—particularly the PATIENT DISCONNECTION alarm, maximum inspired volume (Max VTI), and minimum inspired volume (Min VTI) settings—must be periodically adjusted according to changes in the patient circuit resistance—especially when filters are replaced. Adding attachments to the ventilator breathing system can cause the pressure during exhalation at the patient connection port to increase.
WARNING:
To ensure proper performance of the ventilator, use a patient circuit recommended by Covidien in
this manual; refer to Chapter 6 , “ Installation and Assembly ” and Appendix
.” The total specified length of the patient circuit tubing as measured from the ventilator outlet to the ventilator inlet is 1.1 meters (3.6 feet) to 2.0 meters (6.6 feet). The tubing must conform to all applicable standards and must be fitted with Ø 22 mm terminals that also conform to all applicable standards. Ensure that both the length and the internal volume of the patient circuit are appropriate for the tidal volume: a corrugated tube of Ø 22 mm for adult patients, and a corrugated tube of Ø 15 mm for pediatric patients with a tidal volume lower than
200 ml.
WARNING:
To ensure proper performance of the ventilator, use only accessories (including oxygen accessories) approved and recommended by Covidien. See Appendix
, “
” or contact your local Covidien Sales or Service Representative.
WARNING:
The oxygen supply hose ages even when it is not in use and should be replaced periodically. The expiration date may be located on the back of the hose end-piece.
WARNING:
When using non-invasive ventilation (NIV) without an exhalation valve, use a vented nose or face mask or a non vented mask combined with a leak accessory. When using non-invasive ventilation
(NIV) with an exhalation valve, use a non-vented mask.
1-16 Clinician's Manual
Warnings
WARNING:
Before using the Nurse Call system, ensure that its connections are secure and it operates properly.
WARNING:
To connect the ventilator to a Nurse Call device, check the ventilator's compatibility with the Nurse
Call device and order a suitable connection cable.
WARNING:
Do not use Nurse Call devices that operate based on the closure of an electrical circuit, because the devices often do not take into account possible cable disconnection or a total loss of power. Ensure that the Nurse Call device is always connected to the ventilator.
WARNING:
To prevent any interference with the internal sensors of the ventilator, do not install a humidifier upstream of the ventilator.
WARNING:
The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation.
1.2.11
Warnings Regarding Maintenance
WARNING:
If a problem with the ventilator is suspected, FIRST CHECK THAT THE PATIENT IS NOT IN DANGER.
If necessary, remove the patient from the ventilator and provide an alternative means of ventilation.
WARNING:
Never use a ventilator or any components or accessories that appear to be damaged. If any signs of damage are evident, contact your equipment supplier or Covidien.
WARNING:
If the ventilator is damaged or its external housing is not correctly closed or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odor, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately.
Clinician's Manual 1-17
Safety Information
WARNING:
If the ventilator fails the alarm tests or if you cannot complete the tests, refer to section
“ Troubleshooting ” or call your equipment supplier or Covidien.
WARNING:
Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only personnel authorized and qualified by Covidien should repair, open or service the ventilator.
WARNING:
Regularly clean the ventilator’s Dual Bag according to manufacturer’s recommendations.
WARNING:
Before cleaning the ventilator, first disconnect the ventilator and the patient circuit.
WARNING:
The ventilator should never be immersed in any liquid, and any liquid on the surface of the device should be wiped away immediately.
WARNING:
To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator.
WARNING:
The air inlet filter is for use on a single patient and is not reusable; do not attempt to wash, clean, or reuse it.
WARNING:
Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over; see Chapter
,
“ Routine Maintenance .” This is particularly important when the ventilator is installed on a
wheelchair, because environmental conditions may cause the filter to become dirty more rapidly.
WARNING:
Before cleaning the ventilator, first disconnect the ventilator and the patient circuit. If the ventilator is used indoors, the condition of the air inlet filter should be checked monthly. If the ventilator is used outdoors or in a dusty environment, the filter should be checked weekly and replaced as necessary.
1-18 Clinician's Manual
Warnings
WARNING:
To ensure proper servicing and avoid the possibility of physical injury to personnel or damage to the ventilator, only personnel authorized and qualified by Covidien should attempt to service or make authorized modifications to the Puritan Bennett™ 520 Ventilator.
WARNING:
If you cannot determine the cause of a problem with your ventilator, contact your equipment supplier. Do not use the ventilator until the problem has been corrected.
WARNING:
To ensure proper performance of the ventilator, the preventative maintenance schedule should be followed. For further information contact Covidien.
WARNING:
On a daily basis, ensure the proper connection and operation of the patient circuit.
WARNING:
After assembling, cleaning, or reassembling the patient circuit, and on a daily basis, inspect the hoses and other components to ensure that there are no cracks or leaks and that all connections are secure.
WARNING:
Use all cleaning solutions and products with caution. Read and follow the instructions associated with the cleaning solutions you use to clean your ventilator. Use only those solutions listed in
WARNING:
Never use a liquid cleaner inside the patient circuit, or on any component of a gas pathway. Clean the patient circuit only as specified by the manufacturer's instructions.
WARNING:
The patient circuit is intended for single use by a single patient and should be changed according to the manufacturer’s recommendations and according to the patient circuit lifetime.
Refer to the instructions for use supplied by the manufacturer of the patient circuit (included with the ventilator) and to Chapter
, “
WARNING:
A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection.
Clinician's Manual 1-19
Safety Information
WARNING:
Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over (see Chapter
,
“ Routine Maintenance ”). This is particularly important when the ventilator is installed on a
wheelchair, because environmental conditions may cause the filter to become dirty more rapidly.
WARNING:
If the ventilator is damaged or its external housing is not correctly closed or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odor, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately.
1.2.12
Warnings to Protect the Environment
WARNING:
Batteries should be disposed of according to environmental legislation in your country and locality.
WARNING:
For environmental protection, the ventilator and its components, whatever their respective conditions of operation, cannot be disposed of with household waste and must be submitted for suitable selective collection and possible recycling of the materials. Observe all applicable regulations when disposing of the ventilator and any of its components.
1.2.13
Warnings Regarding USB Memory Device
WARNING:
Always verify the file ID before using a USB memory device to transfer data between the ventilator and a PC.
1-20 Clinician's Manual
Symbols and Markings
1.3
Symbols and Markings
Symbols
Table 1-1. Ventilator Symbols
Descriptions
It is essential to read, understand, and follow these instructions before using the Puritan Bennett 520
Ventilator (ISO 7000-0434A).
This symbol appears on the ventilator’s back panel, see
Type BF applied part (IEC 60417-5333).
A regulatory standard classification for protection against electrical shock for the part of the device that contacts the patient.
This symbol appears on the ventilator’s back panel; see
Direct current, DC (IEC 60417-5031).
This symbol appears on the ventilator’s back panel and keyboard; see
Alternating current, AC (IEC 60417-5032).
This symbol appears on the ventilator’s back panel and keyboard; see
, item 10.
Internal battery.
This symbol appears on the ventilator’s keyboard; see
Figure 2-3. on page 2-7 , item 10.
Insulation class II equipment (IEC 60417-5172).
A regulatory standard classification for protection against electric shock. Class II equipment relies on double insulation rather than protective earthing. This symbol appears on the ventilator’s back panel;
Index of Protection rating for the ventilator’s enclosure, defined in IEC 60529 (BSEN60529:1991).
The first digit, 3, indicates protection against the intrusion of small foreign bodies (including fingers, tools, wires, etc. with a diameter greater than 2.5 mm) into the ventilator. The second digit, 1, indicates protection against water dripping or falling vertically, as well as an environment featuring water vapor condensation and/or light rain.
This rating appears on the ventilator’s back panel; see Table 1-2. , item 4.
CSA—Canadian Standards Association.
This symbol appears on the ventilator’s back panel; see
CE—Conformity European
Signifies compliance with the medical device directive 2007/47/EC.
This symbol appears on the ventilator’s back panel; see
This symbol appears on the ventilator’s front panel UP key; see
on page
This key is used to: move the LCD display’s cursor upwards, line-by-line; increase the value of displayed and selected parameter setting.
This symbol appears on the ventilator’s front panel DOWN key; see Figure 2-3. on page 2-7 , item 6.
This key is used to: move the LCD display’s cursor downwards, line-by-line; decrease the value of displayed and selected parameter settings.
Clinician's Manual 1-21
Safety Information
Symbols
Table 1-1. Ventilator Symbols (Continued)
Descriptions
This symbol appears on the ventilator’s front panel ENTER key; see
Figure 2-3. on page 2-7 , item 5.
This key is used to confirm command actions.
This symbol appears on the ventilator’s front panel ALARM CONTROL key; see
item 2.
This key is used to: cancel the audible portion of alarms for 60 seconds at a time; cancel an alarm. For
more information, see Appendix F
,
This symbol appears on the ventilator’s front panel MENU key; see
, item 7.
This key is used to access the ventilator’s menus via the ventilator’s front panel LCD display.
This symbol (IEC 60417– 5009) appears on the ventilator’s front panel VENTILATION ON/OFF button; see
Figure 2-3. on page 2-7 , item 8.
This key is used to start and stop ventilation.
To patient port.
This symbol appears on the front right of the ventilator, adjacent to the To patient port; see
item 1.
Patient proximal pressure port.
This symbol appears on the front right of the ventilator, adjacent to the To patient port; see
Figure 1-1. on page 1-27 , item 3 and
Exhalation valve pilot port.
This symbol appears on the front right of the ventilator, adjacent to the To patient port indicating the connection of the tubing between the patient circuit exhalation valve; see
Figure 1-1. on page 1-27 , and
Figure 1-3. on page 1-28 , item 3.
Oxygen inlet.
, item 2.
Nurse call connector.
This symbol appears on the back panel of the ventilator, adjacent to the nurse call connector; see
Figure 1-2. on page 1-27 , item 10.
Switch in “Off” position (IEC 60417-5008).
This symbol appears on the I/O (power on/off) switch on the back panel of the ventilator to indicate the
switch’s “Off” position. See Figure 2-2.
on page
Switch in “On” position (IEC 60417-5007).
This symbol appears on the I/O (power on/off) switch on the back panel of the ventilator to indicate the
switch’s “On” position. See Figure 2-2. on page 2-6 , item 2.
Software lock enabled.
This symbol appears on the upper-left of the ventilator’s LCD display when the keyboard Locking key is
, “
1-22 Clinician's Manual
Clinician's Manual
Symbols
Symbols and Markings
Table 1-1. Ventilator Symbols (Continued)
Descriptions
Internal battery.
This symbol appears on the top-center of ventilator’s LCD display to indicate that the ventilator is being powered by its internal battery. See
, item 1 and Chapter 8 , “ Internal Battery ,” for
more information.
Pressure rise time (inspiratory phase) parameter.
These symbols appear on the ventilation mode menu screens. For more information, see Chapter 3 ,
“
.” In pressure ventilation modes, you can select one of four rise times with setting
1 representing the fastest rise time and setting 4 representing the slowest.
Selected line (filled square).
When making menu choices, this graphic indicates the line on which the cursor is currently positioned.
,
Selecting the Preferences Menu , on page 7-15
.
Non-selected line (empty square).
When making menu choices, this graphic indicates a line on which the cursor is currently not positioned.
Locked parameter line.
When making menu choices, this graphic indicates a line that cannot be selected (the Locking key is enabled).
Active parameter line.
When making menu choices, this graphic indicates that the current parameter is selected and can be changed. See Chapter
Inspiratory effort detected.
This symbol appears in the front panel display’s Status window when the patient triggers a breath.
Parameter adjustment bar.
This graphic shows the current setting for parameters such as display contrast and alarm volume in the
Preferences menu. See section
, Preferences Menu Parameters .
WEEE (Waste Electrical and Electronic Equipment).
This symbol means that this product must not be disposed of with household waste. Observe local ordinances for proper disposal. See
Year of manufacture.
Manufacturer.
Audio Paused (alarm key once).
This symbol means the sounding of audible alarms is currently disabled.This period lasts for 60 seconds.
For more information, see section
, “ Pausing the Audible Portion of Alarms .”
1-23
Safety Information
Symbols
Table 1-1. Ventilator Symbols (Continued)
Descriptions
Alarm Paused (alarm key twice).
This symbol means one or more alarms have been paused or reset/canceled. The alarm is paused until the alarm condition is corrected and the condition reoccurs. For more information, see section
Alarm off (Apnea off).
This symbol means that the Apnea alarm has been set to OFF in the Preferences menu. For more information, see section
.”
Exhalation valve detected.
This symbol means that an exhalation valve has been detected during ventilation.
No exhalation valve detected.
This symbol means that no exhalation valve has been detected during ventilation.
Follow instructions for use (ISO 7000-1641).
This symbol directs the user to observe and adhere to the instructions contained in the product’s user manuals.
USB port.
This symbol indicates a communications port for interfacing with a USB connector. See
, item 9.
PC connector.
This symbol indicates a port that can be used by authorized Puritan Bennett product service personnel or Covidien service personnel for software maintenance. See
Atmospheric pressure limitation.
Humidity limitations.
Temperature limitations.
Fragile.
1-24 Clinician's Manual
Symbols
Keep dry.
Table 1-1. Ventilator Symbols (Continued)
Descriptions
Keep away from direct sunlight.
This side up.
Symbols and Markings
Clinician's Manual 1-25
Safety Information
1.4
Labels / Identification and Instruction Information
Various labels or specific markings are affixed to the ventilator that describe precautions to be taken for the correct use of the ventilator and contribute to the traceability of the product. See
and the figures on the following pages for illustrations of these labels and markings and their locations on the ventilator. Use the item numbers in
Table 1-2. to locate the labels in
Table 1-2. Ventilator Labels and Markings
1. Patient gas inlet label
(
2. Oxygen inlet marking and label
(
3. Exhalation valve and patient pressure connection label (
)
4. Air inlet label (
5. Identification label ( Figure 1-3. )
1 Location of AC power cable connector
6. AC power (mains) cable connector marking
(
1 Location of DC power cable connector
7. External cable connector marking
(
8. PC connection marking
(
N/A
10. Nurse call cable connector Marking
(
1-26
9. USB port marking
(
N/A
Clinician's Manual
Labels / Identification and Instruction Information
Note:
The item number callouts in the following figures refer to those listed in
Figure 1-1. Locations of Labels—Top-Front View
Figure 1-2. Location of Labels and Markings—Rear View
Clinician's Manual 1-27
Safety Information
Figure 1-3. Location of Labels—Bottom View
1-28 Clinician's Manual
2 Ventilator Overview
2.1
Indications for Use
•
•
The Puritan Bennett™ 520 Ventilator is indicated for the continuous or intermittent mechanical ventilatory support of patients weighing at least 11 lb (5 kg) who require mechanical ventilation.
The ventilator is a restricted medical device intended for use by qualified, trained personnel under the direction of a doctor. It is essential to read, understand, and follow these instructions before using the Puritan Bennett™ 520 Ventilator.
Target Patients
•
Specifically, the ventilator is applicable for adult and pediatric patients who require the following general types of invasive or non-invasive ventilatory support, as prescribed by an attending doctor:
Positive Pressure ventilation
Assist/Control, PSV, or CPAP modes of ventilation
Breath types, including Pressure Control and Pressure Support
Target Environments
The ventilator is suitable for use in institutional, home, and portable settings. It is not intended for use as an emergency transport ventilator.
The Puritan Bennett 520 Ventilator is suitable for use on commercial aircraft, per FAA requirements. See section
, “ Standards Compliance and IEC Classification .” Patients traveling with the
Puritan Bennett 520 Ventilator may be required by their airline to demonstrate evidence of compliance with the RTCA/DO-160F standard, as well as other requirements. Contact your airline prior to travel to determine airline-specific requirements and documentation.
WARNING:
Even though the Puritan Bennett™ 520 Ventilator meets current safety standards, and although the internal Lithium-ion battery of the device is considered to be Dangerous Goods for transport in commerce, this devices lithium battery is below the 100Wh threshold and is therefore excepted from being a Class 9 – Miscellaneous - Dangerous Goods (DG). As such, the Puritan
Bennett™ 520 Ventilator and/or the associated Lithium-ion battery are subject to some transport conditions under the Dangerous Goods Regulation for air transport (IATA: International Air
Transport Association), International Maritime Dangerous Goods code for sea and the European
Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) for
2-1
2-2
Ventilator Overview
•
•
•
•
Europe. Private individuals who transport the device are excluded from these regulations although for air transport some requirements apply. For air transport; the Puritan Bennett™ 520
Ventilator is permitted as checked-in or carry-on baggage. Spare batteries may be taken on board as carry-on luggage only. This classification and regulatory requirements may vary depending upon the country and mode of transport. Therefore it is recommended that users verify with the carrier / airline as to which measures to take before the voyage.
Target Operators
•
The ventilator may be operated by the following caregivers:
Respiratory therapists
Doctors
Nurses
Homecare providers
Patient and patient’s families
For more details on the knowledge and skill requirements for operating the Puritan Bennett 520
Ventilator, see Appendix
, “
Patient/Caregiver Checklist .”
WARNING:
This ventilator must be used only under the responsibility and on the prescription of a doctor.
WARNING:
The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent.
2.2
Contraindications
This ventilator is not for use with anesthetic gases, and is not intended for use as an emergency transport ventilator. It is not intended to be used for patients without breathing autonomy or who are ventilator dependent.
2.3
Operational Use
•
•
The Puritan Bennett 520 Ventilator uses a micro-turbine to provide ventilatory support to patients.
Clinicians may use a variety of interfaces to connect patients to the ventilator for continuous or intermittent ventilatory support. Some examples include mouthpieces; nasal masks or full face masks; endotracheal tubes or tracheotomy tubes. User-selectable ventilation modes include the following types:
Assisted Controlled Pressure (P A/C)
Continuous Positive Airway Pressure (CPAP)
Clinician's Manual
Operational Use
• Pressure Support Ventilation with apnea ventilation (PSV/ST)
Safety Net
Incorporated in the ventilator design is an alarm system that continuously monitors both patient and machine for signs of specific errors or faults that could lead to an unsafe condition. Should any of these errors or faults be detected, the alarm system announces the specific alarm condition both audibly and visually. The machine-related alarm conditions are factory set, whereas the patient-related alarm conditions are defined by alarm-threshold values selected by an operator (a
clinician or a caregiver). For more information, see Chapter 5 , “ Alarms and Troubleshooting .”
WARNING:
Patients on home care ventilation equipment should be appropriately monitored by clinicians, caregivers and suitable monitoring equipment, as advised by the patient’s clinician. The Puritan
Bennett™ 520 Ventilator is not intended to be a comprehensive monitoring device and does not activate alarms for all types of dangerous conditions for patients.
Settings
A software key, known as the Locking key, restricts access to ventilation parameter settings and ventilation mode changes in order to distinguish between clinician usage and patient usage (see
” on page
Oxygen Enrichment
Oxygen may be supplied from an external, low pressure source, but the oxygen flow must be limited to 15 lpm (50 kPa, 7 PSI). The ventilator automatically compensates for the extra flow created by the external oxygen supply (see Chapter
6 , “ Installation and Assembly
.”
WARNING:
To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses.
WARNING:
Oxygen therapy for patients with respiratory failure is a common and effective medical prescription. However, be aware that inappropriate oxygen use may potentially lead to serious complications, including, but not limited to, patient injury.
WARNING:
Users must always possess an additional breathing circuit and exhalation valve while using the
Puritan Bennett™ 520 Ventilator.
Breathing Circuit
The ventilator is used with a single-limb patient circuit. For more information, see section 6.4
“
Patient Circuit ” on page 6-8 .
Clinician's Manual 2-3
Ventilator Overview
2.4
Device Classification
•
•
•
•
•
•
The ventilator’s IEC/EN 60601-1 classification is as follows:
Protection/insulation class (electric shock): Class II
Protection index of enclosure: IP31
Medical device directive classification: II B
Degree of protection against risk of electric shock: BF
Power: external (AC—mains, or DC—cigarette lighter) or internal (DC—battery)
Operation mode: continuous operation
For additional information, see Appendix
2-4 Clinician's Manual
2.5
Front Panel
Figure 2-1. Front Panel
Front Panel
Clinician's Manual
1
2
3
LCD display —Shows information about the ventilator, including patient hours and software version, ventilation modes and settings, and monitored and calculated patient data. The display also allows the user to view and, using the control panel, adjust the ventilator’s operating and alarm configuration settings.
4
Control panel —Features the controls for setting up and operating the ventilator, and LEDs to indicate the ventilator's power source, ventilation on/off status, and alarm priority level. Control functions include turning on and off the ventilation, configuring ventilation modes, pausing audible alarms, canceling alarms, and setting device and alarm parameters.
5
Patient connection port —Provides an outlet for the gas to be delivered to the patient via the patient circuit.
6
Patient pressure monitoring port —Nipple for monitoring proximal patient pressure.
Exhalation valve port —Nipple for providing piloting pressure to the exhalation valve. Controls the openclosed position of the exhalation valve.
Lateral and front openings – Vents that allow for air circulation to cool the ventilator’s internal components.
In addition, these openings function as sound ports for audible alarms.
WARNING:
Do not cover or obstruct these openings.
2-5
Ventilator Overview
2.6
Back Panel
Figure 2-2. Back Panel
2-6
1 Ergonomic carrying handle.
2 On/off (I/O) switch with protective cover:
Device powered on in position I; device switched off in position 0.
3 AC power (“mains”) cable connector.
4 AC power (“mains”) cable holding system:
Secures AC power cable to avoid accidental disconnection.
5 Access cover for the internal battery.
6 DC power cable connector with key.
7
8
9
PC cable connector:
USB mini-B connector used for Puritan Bennett Ventilator test software.
O
2
inlet port:
Connects the ventilator to a low pressure oxygen source via an adapter connected to the O
2
Inlet (see section
” on page
Nurse call output connector:
Used to connect the ventilator to the nurse call system.
10 USB memory device connection:
USB connection to be used with Puritan Bennett Respiratory Insight Software. There are two USB type A ports.
11 Air inlet filter:
Filters air as it enters the ventilator.
WARNING:
Do not cover or obstruct these openings.
Clinician's Manual
2.7
Control Panel
Figure 2-3. Control Panel
Control Panel
1 Alarm indicators (two LEDs):
Red indicator:
• Continuous: very high priority (VHP) alarm activated
• High priority (HP) alarm activated.
Yellow indicator:
• Medium priority (MP) alarm activated.
6 DOWN key:
• Moves the cursor down and decreases parameter values.
2 ALARM CONTROL key:
• Press once to pause an audible alarm for 60 seconds.
• Press twice to halt visual and audible alarms. If alarm is remedied, the alarm is canceled (other than the high pressure alarm).
7 MENU key:
Changes the menu shown. From the Ventilation menu screen, press this key to show the Alarm menu screen.
When a USB memory device is inserted into the ventilator, press this key to show the USB memory device screen.
3 Display screen:
Shows modes, ventilation settings, patient data, configuration of the ventilator, and alarm management.
8 VENTILATION ON/OFF button:
• ON: Press briefly and release to start ventilation.
• OFF: Press and hold for 3 seconds, then press again to stop ventilation.
4 UP key:
•Moves the cursor up and increases parameter values.
9 Ventilation status indicator:
Blue indicator illuminated: Device is turned on and ventilation is off (on standby).
Blue indicator off: Ventilation is on.
5 ENTER key:
• Access to a setting value and validation of the modification of this setting.
• Access to a sub-menu.
10 Electrical power source indicators:
• AC POWER indicator lit: AC power source connected.
• DC POWER indicator lit: DC power source connected.
• INTERNAL BATTERY indicator lit continuously: internal battery in use (no external power source connected.)
• INTERNAL BATTERY indicator flashing: battery charging.
Clinician's Manual 2-7
Ventilator Overview
2.8
Ventilation Menu
Figure 2-4. Ventilation Menu Display
2-8
Ventilation menu with ventilation on standby.
Ventilation menu during ventilation.
1 General information line:
Shows the current ventilation mode, along with the following:
• Battery symbol if the device is powered by the internal battery.
• Audio paused symbol if an alarm is currently inhibited.
2 Ventilation settings:
Shows the specific ventilation parameter values for the currently selected ventilation mode. See Chapter
for more information.
3 Preferences menu access line:
Highlight this line and press the
ENTER ences menu.
key to show the Prefer-
See manual section
Menu Parameters ” on page 7-14 for
more information.
• Alarm paused symbol if an alarm has been canceled manually and the cause of the alarm remains.
• Apnea alarm deactivation .
• Exhalation valve symbol.
• No exhalation valve symbol.
• Absolute ABS symbol.
• Relative REL symbol.
4 Bargraph:
Shows pressure generation during ventilation.
5 Status/monitored data window:
• Ventilation stopped (standby): shows the message, “PRESS
TION.”
TO START VENTILA-
• Ventilation on: parameters are monitored and shown.
• The Inspiratory effort detected symbol appears adjacent to the monitored I:E ratio when the patient actively triggers a breath.
6 Alarm conditions window:
• For active alarms, scrolls through active alarm messages in flashing reverse video.
•For inactive alarms, shows the last alarm along with its trigger date and end-of-event time.
See Chapter
“
Alarms and Troubleshooting ” for
details.
Clinician's Manual
2.9
Alarm Menu
Figure 2-5. Alarm Menu
Alarm Menu
Alarm menu with ventilation on standby.
Alarm menu when not in standby.
1 Title line:
Shows ventilation mode and the following symbols:
• Battery symbol if the ventilator is powered by the internal battery.
• Audio paused currently inhibited.
if an alarm is
2 Alarm settings:
Shows the specific alarm parameter values for the currently selected ventilation mode, which are the following:
• Min and max alarm threshold settings, and
• Current monitored patient readings, or hyphen (-) when ventilation is in standby.
3 Access line to Alarm Logs menu.
Highlight this line and press the
ENTER
key to show the
Alarm Logs menu.
See manual section
• Alarm paused if an alarm has been canceled manually and the cause of the alarm remains.
• Apnea alarm deactivation
• Exhalation valve symbol.
.
• No exhalation valve symbol.
4 Status/monitored data window:
• Ventilation stopped (standby): shows the message, “PRESS
TO START VENTILATION.”
• Ventilation on: parameters are monitored and shown.
• The Inspiratory effort detected symbol appears adjacent to the monitored I:E ratio when the patient actively triggers a breath.
5 Alarm message window:
• For active alarms, scrolls through active alarm messages in flashing reverse video.
• For inactive alarms, shows the last alarm along with its trigger date and endof-event time.
See Chapter
5 , “ Alarms and Troubleshooting
” for details.
Clinician's Manual 2-9
Ventilator Overview
2.10
USB Memory Device Menu
Figure 2-6. USB Memory Device Menu
1 Title line 3 USB Memory Device menu
2 Ventilator serial number 4 Dialog box
2.11
If Ventilator Failure Occurs
If a problem with the ventilator is suspected, FIRST CHECK THAT THE PATIENT IS NOT IN DANGER.
If necessary, remove the patient from the ventilator and provide an alternate means of ventilation.
Keep in mind that troubleshooting information is available in this manual to assist you in the event of a problem. See Chapter
5 , “ Alarms and Troubleshooting
.”
If you cannot determine the cause of a problem, contact your equipment supplier or Covidien.
See section
2-10 Clinician's Manual
3 Operating Parameters
This chapter describes ventilation and alarm parameters and their setting ranges for each ventilation mode. For a listing of operating parameters and monitored patient data, see
. For further information about the different ventilation modes and breath types provided by the Puritan Bennett™ 520 Ventilator, see Appendix
.”
WARNING:
The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent.
WARNING:
If APNEA TIME is set to a value higher than 60/Rate then the APNEA alarm will not activate.
Note:
Before choosing settings for operating parameters and alarms, be sure to carefully review the warnings regarding settings. See section
3.1
PSV Mode Parameters and Setting Ranges
The menus for PSV—Pressure Support Ventilation mode are shown in
:
Figure 3-1. Menus in PSV Mode with Exhalation Valve Configuration
3-1
Operating Parameters
Figure 3-2. Menus in PSV Mode with Leakage Configuration
3-2
The ventilation parameters and setting ranges available in PSV mode are listed in Table 3-1.
Name
P Support
PEEP
Rise Time
I Sens
E Sens
1
Backup R
Units cmH
2 hPa cmH
2 hPa
–
–
%
O, mbar, or
O, mbar, or
Table 3-1. Ventilation Parameters in PSV Menu
Min. value Max. value
Adjustment resolution
1 Standby: 2
Valve configuration: 5
Leak configuration: 6
Standby: OFF
Valve configuration:
OFF
Leak configuration: 4
1
Standby: 55
Valve configuration: 55
Leak configuration: 30
20
4
1
1
0P
5 (-95)
5
95 (-5)
Apnea Time
Vt Target
Min I Time
Max P bpm s ml s mbar
4
1
50
0.1
8
40
60
2000
2.8
55
Max I Time s 0.8
3
1
See Chapter
7 , “ Operating Procedures ” for information on positive and negative E Sens settings.
1
5
1
1
10
0.1
1
0.1
Default value
15
OFF
2
2
Auto
13
Auto
OFF = 100
Auto
Pi + 3
Auto
Linked parameters
PEEP
P Support
Max P
I Time
–
–
Min I Time
Backup R
–
Max I Time
-
Min I Time
Clinician's Manual
PSV Mode Parameters and Setting Ranges
Table 3-2. lists the available alarm settings in PSV mode.
Name
Min VTI
Max VTI
Max Leak (with leak configuration)
Max Rtot
Units ml ml lpm
Table 3-2. Alarm Parameters in PSV Mode
Min. value Max. value Adjustment resolution
30 2000 10
80
5
3000
200
10
5
Default value
300
2,000
OFF
Linked parameters
Max VTI
Min VTI
bpm 10 70 1 OFF Backup R
P Support—Pressure Support
When Relative pressure is set to YES in the Setup menu, P Support allows you to determine inspiratory pressure added to PEEP during the inspiratory phase.
In this configuration, the sum of P Support and PEEP must not exceed 55 mbar.
When Relative pressure is set to OFF in the Setup menu, P Support allows you to determine inspiratory absolute pressure.
In this configuration, P Support and PEEP are related and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration.
PEEP—Positive End Expiratory Pressure
PEEP allows you to determine the level of pressure maintained during the exhalation phase.
When Relative pressure is set to YES in the Setup menu, the sum of P Support and PEEP must not exceed 55 mbar.
When Relative pressure is set to OFF, P Support and PEEP are related and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration.
The ventilation mode can be adjusted without PEEP (PEEP is nearly 0 mbar when set to OFF) in valve configuration.
In leak configuration, the minimum PEEP setting is 4 mbar.
Rise Time
This parameter is used during the inspiration phase to determine how the target pressure will be reached. This setting indirectly defines the minimum inspiratory time.
The different levels available are as follows:
Rise time
Rise time
= 200 ms
= 400 ms
Rise time = 600 ms
Clinician's Manual 3-3
3-4
Operating Parameters
Rise time = 800 ms
These time ranges are determined by the pressure setting required, the breath rate, and the physiological condition of the patient.
I Sens—Inspiratory Trigger Sensitivity
I Sens allows you to set the level of inspiratory effort the patient has to provide during the initiation of a machine breath.
The sensitivity levels are 0P, 1P, 2, 3, 4, and 5 (P denotes pediatric use); the lower the number, the more sensitive the trigger sensitivity.
I Sens can be set to OFF.
WARNING:
Ensure that the I Sens setting is not set to OFF when ventilating patients capable of triggering spontaneous breaths.
WARNING:
Carefully modify the trigger threshold setting to reduce the risk of ventilator autotriggering. Level
0P, the most sensitive inspiratory trigger, is recommended for pediatric use. For an adult, this setting may result in ventilator autotriggering.
E Sens—EXHALATION SENSITIVITY
E Sens is available in PSV mode.
E Sens allows you to determine sensitivity of switching to exhalation and thus indirectly determines the inspiratory time of a breath.
The end of inspiration will occur when inspiratory flow has decreased to the preset E Sens setting.
The exhalation trigger is only taken into account after the Rise Time (which constitutes a default minimum inspiratory time) has elapsed.
If the flow drop is insufficient, exhalation is automatically triggered independently of the E Sens, which is defined as a percentage of peak inspiratory flow. Exhalation may be triggered if the maximum inspiratory time setting has elapsed. For more information about maximum inspiratory time, see Min and Max I Time—Minimum/Maximum Inspiration Time.
Clinician's Manual
Figure 3-3. Exhalation Trigger Sensitivity
PSV Mode Parameters and Setting Ranges y2 Exhalation x Seconds y1 Inspiration
Note:
, “ Changing the Setup Menu Parameters ” for positive and negative E Sens settings.
Backup R
Backup R allows you to determine the frequency of ventilation breaths to be applied in the event of prolonged apnea—as long as no inspiratory trigger is detected.
The inspiratory time of the backup breaths applied in the event of apnea still depends on the detection of exhalation trigger (E Sens) and the safety maximum inspiratory time (see above comment on E Sens). The rise time of these cycles is identical to the ventilation cycle previously set.
The controlled cycles following apnea are interrupted as soon as a new spontaneous inspiration of the patient is detected.
The Backup R is linked to the Min I Time so that the Min I Time setting cannot be greater than half the inspiratory phase of a ventilator-controlled breath.
Backup R breath is delivered at the Pressure Support settings.
Setting a backup rate is not optional; it is always set.
3.1.1
Apnea Time
Apnea time allows the user to monitor and detect interruptions to the patient's spontaneous breathing pattern. The ventilator declares apnea when no breath has been delivered by the time that the operator-selected apnea interval elapses.
Clinician's Manual 3-5
3-6
Operating Parameters
The APNEA TIME adjustment range shall be 1 to 60 seconds. The ventilator shall enable the operator to set an auto-setting. The Apnea time AUTO setting (in seconds) is calculated using the formula (Auto = maximum value between 3 seconds and 60/Backup R or AUTO = 30 in CPAP mode).
Note:
During apnea ventilation, the ventilator delivers machine-controlled breaths according to a backup rate
(Backup R)—as long as no inspiratory trigger has been detected.
Note:
The Backup R value applied depends on the Rate setting.
Note:
If the Apnea alarm is set to OFF in the Preferences menu, the Apnea time setting will still be active.
Vt Target—TARGET TIDAL VOLUME
Vt Target allows the ventilator to deliver a target volume of gas to the patient.
When a Vt Target is set, the ventilator constantly adjusts the target inspiratory pressure between
Pi and Max P to ensure the inspired tidal volume remains as close as possible to the Vt target.
Vt Target should be more than 10 ml lower than Max VTI to avoid triggering a VTI alarm. The minimum increase or decrease of target inspiratory pressure is 0.5 mbar and the maximum is
2 mbar.
Setting the Vt Target is not mandatory (it can be set to OFF).
Max P—MAXIMUM INSPIRATION PRESSURE
Max P allows the ventilator to adjust the inspiratory pressure up to a maximum limit in order to reach the target tidal volume (Vt Target).
P Support and Max P are related and the difference between them must be less than 20 mbar.
Max P is not shown when Vt Target is set to OFF.
Min and Max I Time—MINIMUM / MAXIMUM INSPIRATION TIME
Min I Time and Max I Time are ventilation parameters that can be adjusted in the alarm menu.
Min I Time defines the minimum duration of time the inspiratory phase is maintained. It takes priority over activation of the exhalation trigger, which can only be triggered after the Min I Time has expired.
The Backup R is linked to the Min I Time so that the Min I Time setting cannot be greater than half the inspiratory phase of a cycle triggered by the ventilator.
If Backup R is changed, Min I Time is, if necessary, automatically readjusted so that the difference between them is always maintained.
Clinician's Manual
PSV Mode Parameters and Setting Ranges
The minimum time by default if no parameter is set (Min I Time = AUTO) corresponds to the Rise
Time to which an operating margin of 0.3 seconds is added. See “ Rise Time ” on page 3-3 for details
about Rise Time.
Max I Time defines the maximum duration of time during which the inspiratory phase is maintained. The switch-over to exhalation occurs, at the latest, after this time has expired.
By default, if no parameter is set, the maximum time (Max I Time = AUTO) is the shortest time between a fixed time of 3 seconds and half the duration of the patient’s inspiratory breaths expressed in seconds. (AUTO equals the lesser of 3 seconds or 30/Rate). This default value will be applied if it is lower than the Max I Time setting.
Min I Time and Max I Time are related so that the Max I Time cannot be set to a value lower than the Min I Time.
VTI (Min and/or Max Alarm Settings)—INSPIRATORY TIDAL VOLUME
It is possible to set a minimum, maximum, or both Tidal Volume alarm threshold for the patient’s inspired tidal volume during a cycle.
This setting is used to trigger an alarm if the tidal volume inspired by the patient is lower than the minimum threshold set (LOW VTI alarm) or greater than the maximum threshold set (HIGH VTI alarm). See Chapter
5 , “ Alarms and Troubleshooting .”
Min VTI and Max VTI are related, and their settings must be set to values that maintain a minimum difference of 20 ml between the two.
It is not mandatory to set the minimum and maximum VTI alarm limits. When the minimum and maximum VTI alarm limits are not set, the display will read OFF for these settings.
Max Leak (Max Alarm Settings)
The setting of a high leakage threshold enables a HIGH LEAKAGE alarm to be triggered in the event the calculated leakage flow exceeds this limit. The displayed value corresponds to the mean parasite leakage flow observed during the exhalation phase.
Max Leak is shown when ventilating without an exhalation valve.
Setting the Max Leak is not mandatory (it can be set to OFF), but the measured value is always shown.
Max Rtot (Max Alarm Setting)—TOTAL BREATH RATE
The maximum rate threshold set is used to warn of hyperventilation or ventilator autotriggering.
The alarm setting is used to trigger the HIGH RATE alarm. See Chapter
5 , “ Alarms and Troubleshooting .”
When set, the Max Rtot threshold must always exceed the backup rate by 5 bpm. If the backup rate is readjusted, the Max Rtot is automatically readjusted to maintain a minimum difference of
5 bpm.
Setting the Max Rtot is not mandatory (it can be set to OFF), but the measured value is always shown.
Clinician's Manual 3-7
Operating Parameters
3.2
CPAP Mode Parameters and Setting Ranges
The menus in CPAP (Continuous Positive Airway Pressure) ventilation mode are shown in
Figure 3-4. Menus in CPAP Mode in Leakage Configuration
3-8
The ventilation parameters and setting ranges available in CPAP mode are listed in
Name
PEEP
Units cmH
2
O, mbar or hPa
Table 3-3. Ventilation Parameters in CPAP Menu
Min. value Max. value Adjustment resolution
4 20 1 s 1 60 1
Apnea Time
1
1.
Not available if Apnea alarm is set to OFF in Preferences menu.
lists the available alarm settings in CPAP mode.
Default value
10
Auto
Linked parameters
Pi
Backup R
Name Units
Table 3-4. Alarm Parameters in CPAP Mode
Min. value Max. value Adjustment resolution
30 2000 10
80
5
3000
200
10
5
Default value
Min VTI
Max VTI
Max Leak ml ml lpm
300
2000
OFF
Linked parameters
Max VTI
-
Min VTI
Max Rtot bpm 10 70 1 OFF Backup R
WARNING:
The CPAP mode does not provide a set respiratory rate. Do not use this mode if it is not appropriate for the patient’s condition.
Clinician's Manual
CPAP Mode Parameters and Setting Ranges
Note:
Only leak configuration is available in CPAP mode.
PEEP—Positive End Expiratory Pressure
PEEP allows you to determine the level of pressure maintained during the exhalation phase.
The ventilation mode can be adjusted without PEEP (PEEP is nearly 0 mbar when set to OFF).
A PEEP value can be set to determine the level of pressure maintained during the inspiratory phase and the exhalation phase.
Apnea Time
Apnea time allows the user to monitor and detect interruptions to the patient's spontaneous breathing pattern. The ventilator declares apnea when no breath has been delivered by the time that the operator-selected apnea interval elapses.
The Apnea time AUTO setting is 30 seconds.
Apnea time is not available if Apnea alarm is set to OFF in the Preferences menu.
VTI (Min and/or Max Alarm Settings)—INSPIRATORY TIDAL VOLUME
It is possible to set a Min, Max, or both Tidal Volume alarm threshold for the patient’s inspired tidal volume during a cycle.
This setting is used to trigger an alarm if the tidal volume inspired by the patient is lower than the minimum threshold set (LOW VTI alarm) or greater than the maximum threshold set (HIGH VTI alarm). See Chapter
5 , “ Alarms and Troubleshooting .”
Min VTI and Max VTI are related, and their settings must be set to values that maintain a minimum difference of 20 ml between the two.
It is not mandatory to set the minimum and maximum VTI alarm limits. When the minimum and maximum VTI alarm limits are not set, the display will read OFF for these settings.
Max Leak (Max Alarm Settings)
The setting of a high leakage threshold enables a HIGH LEAKAGE alarm to be triggered in the event the calculated leakage flow exceeds this limit. The displayed value corresponds to the mean parasite leakage flow observed during the exhalation phase.
It is not mandatory to set the maximum Leak alarm limit. When the maximum Leak alarm limit is not set, the display will read OFF for these settings.
Max Rtot (Max Alarm Setting)—TOTAL BREATH RATE
The maximum rate threshold set is used to warn of hyperventilation or ventilator autotriggering.
The alarm setting is used to trigger the HIGH RATE alarm. See Chapter
5 , “ Alarms and Troubleshooting .”
When set, the Max Rtot threshold must always exceed the backup rate by 5 bpm. If the backup rate is readjusted, the Max Rtot is automatically readjusted to maintain a minimum difference of
5 bpm.
Clinician's Manual 3-9
Operating Parameters
Setting the Max Rtot is not mandatory (it can be set to OFF), but the measured value is always shown.
I Sens—INSPIRATORY TRIGGER SENSITIVITY
The trigger threshold for switching to inhalation cannot be set in CPAP mode. The device is configured with a default I Sens of 2.
E Sens—EXHALATION TRIGGER SENSITIVITY
The trigger threshold for switching to exhalation cannot be set in CPAP mode. The device is configured with a default E Sens of 25%.
3.3
P A/C Mode Parameters and Setting Ranges
The menus in P A/C (Pressure Assisted/Controlled) ventilation mode are shown in
and
Figure 3-5. Menus in P A/C Mode with Exhalation Valve Configuration
Figure 3-6. Menus in P A/C Mode with Leakage Configuration
3-10
The ventilation parameters adjustable in P A/C mode are listed in Table 3-5.
Clinician's Manual
P A/C Mode Parameters and Setting Ranges
Name
Pi
PEEP
Rise Time
Rate
Insp Time
I Sens
Vt Target
Max P
Units cmH
2
O, mbar, or hPa
Table 3-5. Ventilation Parameters in PA/C Mode menu
Min. value
Standby: 2
Valve configuration: 5
Leak configuration: 6
Max. value
Standby: 55
Valve configuration: 55
Leak configuration: 30
Adjustment resolution
1
20 1 cmH
2
O, mbar, or hPa
–
Standby: OFF
Valve configuration: OFF
Leak configuration: 4
1 4 1
Default value
15
Linked parameters
PEEP
OFF
2
Pi bpm s
– ml cmH
2
O, mbar, or hPa
1
0.3
OFF
50
8
60
6.0
5
2000
55
1
0.1
1
10
1
13
1.5
2
OFF
Pi + 3
Rate
I/T
Max Rtot
Rate
Apnea Time
–
Min VTI
Max VTI
Pi
PEEP
Table 3-6. lists the adjustable alarm parameters in P A/C mode.
Name
Min VTI
Max VTI
Max Leak
(leakage configuration)
Max Rtot
Units ml ml ml
Table 3-6. Alarm Parameters in PA/C Mode
Min. value
Max. value
Adjustment resolution
30
80
5
2000
3000
200
10
10
5
Default value
300
2000
OFF
Linked parameters
Max VTI
Min VTI
bpm 10 70 1 OFF Rate
Pi—Inspiratory Pressure
When Relative pressure is set to YES in the Setup menu, Pi allows you to determine inspiratory pressure added to PEEP during the inspiratory phase.
In this configuration, the sum of Pi and PEEP must not exceed 55 mbar.
When Relative pressure is set to OFF in the Setup menu, Pi allows you to determine inspiratory absolute pressure.
In this configuration, Pi and PEEP are related, and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration.
Clinician's Manual 3-11
Operating Parameters
PEEP—Positive End Expiratory Pressure
PEEP allows you to determine the level of pressure maintained during the exhalation phase.
When Relative pressure is set to YES in the Setup menu, the sum of Pi and PEEP must not exceed
55 mbar.
When Relative pressure is set to OFF, Pi and PEEP are related and their settings must maintain a minimum difference between the two of 2 mbar in leak configuration and 5 mbar in valve configuration.
The ventilation mode can be adjusted without PEEP (PEEP is nearly 0 mbar when set to OFF) in valve configuration.
In leak configuration, the minimum PEEP setting is 4 mbar.
Rise Time
This parameter is used during the inspiration phase to adjust how the pressure setpoint will be reached. This setting indirectly defines the minimum inspiratory time.
The different levels available are as follows:
Rise time
Rise time
= 200 ms
= 400 ms
Rise time
• Rise Time
= 600 ms
Rise time = 800 ms
These time ranges are determined by the combination of the pressure setting required, the breath rate and the physiological conditions of the patient.
The pressure rise time built-up at each cycle depends on the inspiratory time corresponding to the combination of the rate setting and the Insp Time setting.
is always possible.
• Rise Time is established only if Insp Time ≥0.7 seconds.
• Rise Time is established only if Insp Time ≥0.9 seconds.
• Rise Time is established only if Insp Time ≥1.1 seconds.
Rate—RESPIRATORY RATE
Rate allows you to define the minimal frequency of mandatory ventilator breaths.
If the patient actuates the inspiration trigger, total Rate may increase.
3-12 Clinician's Manual
P A/C Mode Parameters and Setting Ranges
InspTime—INSPIRATORY TIME
This parameter allows the user to set the inspiratory time to 0.3-6.0 s. When changing Insp Time, the ventilator shows the corresponding I:E ratio or I/T% in the settings window. The maximum I:E setting is constrained to 1:1.
I Sens—INSPIRATORY TRIGGER SENSITIVITY
I Sens allows you to set the level of inspiratory effort the patient has to provide to initiate a machine breath.
The sensitivity levels are 0P, 1P, 2, 3, 4, and 5 (P denotes pediatric use); the lower the number, the more sensitive the trigger sensitivity.
I Sens can be set to OFF.
WARNING:
The inspiration trigger threshold should be carefully modified in order to avoid the risk of false triggering or “autotriggering” of the ventilator. For example, Level 0P, the most sensitive mode, is recommended for pediatric use. However, for an adult, this setting may result in autotriggering.
Vt Target—TARGET TIDAL VOLUME
Vt Target allows the ventilator to deliver a target volume of air to the patient.
When a Vt Target is set, the ventilator constantly adjusts the target inspiratory pressure between
Pi and Max P to ensure the inspired tidal volume remains as close as possible to the Vt target.
Vt Target should be more than 10 ml lower than Max VTI to avoid triggering VTI alarm.
The minimum increase or decrease of target inspiratory pressure is 0.5 mbar and the maximum is
2 mbar.
Setting the Vt Target is not mandatory (it can be set to OFF).
Max P—MAXIMUM INSPIRATION PRESSURE
Max P allows the ventilator to adjust the inspiratory pressure up to a maximum limit in order to reach the target tidal volume. (Vt Target)
Pi and Max P are related and the difference between them must be less than 20 mbar.
Max P is not shown when Vt Target is set to OFF.
VTI (Min and/or Max Alarm Settings)—INSPIRATORY TIDAL VOLUME
It is possible to set a Min, Max, or both Tidal Volume alarm threshold for the patient’s inspired tidal volume during a cycle.
This setting is used to trigger an alarm if the tidal volume inspired by the patient is lower than the minimum threshold set (LOW VTI alarm), or greater than the maximum threshold set (HIGH VTI alarm). See Chapter
5 , “ Alarms and Troubleshooting .”
Min VTI and Max VTI are related and their settings must be set to values that maintain a minimum difference of 20 ml between the two.
It is not mandatory to set the minimum and maximum VTI alarm limits. When the minimum and maximum VTI alarm limits are not set, the display will read OFF for these settings.
Clinician's Manual 3-13
Operating Parameters
Max Leak
The setting of a high leakage threshold enables a HIGH LEAKAGE alarm to be triggered in the event the calculated leakage flow exceeds this limit. The displayed value corresponds to the mean parasite leakage flow observed during the exhalation phase.
Max Rtot (Max Alarm Setting)—TOTAL BREATH RATE
The maximum rate threshold setting is used to warn of hyperventilation or autotriggering of the ventilator. This setting is used to trigger the HIGH RATE alarm. See Chapter
5 , “ Alarms and Troubleshooting .”
The Max Rtot threshold must always be set at least 5 bpm higher than the Rate. If the Rate is readjusted, the Max Rtot is automatically readjusted to maintain a minimum difference of 5 bpm.
Setting the Max Rtot is not mandatory (it can be set to OFF), but the measured value is always shown.
3.4
FiO
2
For Various Oxygen and Ventilator Settings
Figure 3-7. FiO
2
for Oxygen and Ventilator Settings
3-14 x y Inhalation flow (l/min) O
2
flow (l/min)
Inhalation flow (LPM) = volume (L) x 60 / inspiratory time (s)
Note:
Tests conducted in a valve configuration. Results can vary according to whether the circuit is configured with or without a valve and patient lung characteristics.
WARNING:
The Puritan Bennett™ 520 Ventilator can be used with an oxygen analyzer with minimum and maximum concentration alarms. Always measure the delivered oxygen with a calibrated oxygen analyzer that features a minimum and maximum concentration alarm in order to ensure that the prescribed oxygen concentration is delivered to the patient.
Clinician's Manual
4 Monitored Parameters
During ventilation, ventilator parameters measured or calculated are highlighted in the menus used for setting the ventilation parameters and the alarms.
In addition to showing monitored ventilation parameters, ventilation is shown graphically, by the pressure bar chart, in the Ventilation parameters setting menu.
Note:
To monitor patient oxygen levels, use an external sensor/alarm.
4.1
Digital Monitoring
•
•
The ventilation parameters monitored or calculated are highlighted in each of the main menus:
Ventilation menu (
,
)
Alarm menu (
Figure 4-1. Ventilation Menu: Pressure Leakage Configuration Modes (CPAP, PSV ST, P A/C)
4-1
Monitored Parameters
Figure 4-2. Ventilation Menu: Pressure Valve Configuration Modes (PSV ST, P A/C)
Figure 4-3. Alarm Menu: Pressure Leakage Modes (CPAP, PSV ST, P A/C)
Figure 4-4. Alarm Menu: Pressure Valve Modes (PSV ST, P A/C)
4-2 Clinician's Manual
Digital Monitoring
4.1.1
Inspiratory Trigger
During each inspiration phase triggered by the patient, the Inspiratory effort detected symbol is
shown beside the cycling I:E ratio in the Ventilation or Alarm menus (see Figure 4-5. ).
The patient triggers the ventilator by inhaling the amount of flow and the ventilator responds by delivering either a pressure-based or volume-based breath.
Figure 4-5. Inspiratory Effort Detected Indicator
4.1.2
Displayed Monitored Parameters
Monitored Parameters Display
Table 4-1. Displayed Monitored Parameters
Description
I:E Ratio
I/T Ratio (I/T)
Inspiratory Tidal Volume
Inspiratory Time
Leak
I:E
I/T
VTI
I Time
Leak
I:E is the ratio of inspiratory time measured to exhalation time measured. The displayed value is updated at each inspiration.
I/T is the breath inspiratory time divided by the total breath cycle time expressed as a percentage. The displayed value is updated at each inspiration.
Flow delivered by the ventilator to the patient at each inspiratory phase is measured by the inspiratory transducer and that measurement is used to calculate volume
(the flow transducers do not directly measure volume).
The displayed value is updated at each inspiration.
Currently, when a Pressure Control or Pressure Support breath is delivered in valve ventilation and a leak is present, the ventilator will increase flow to reach the pressure target. The monitored VTI in Pressure Control or Pressure Support breaths reflects the amount of flow the ventilator delivers from the outlet port during inhalation. The monitored value will increase (possibly to an abnormally high number) when a leak is present. This displayed value is not what is delivered to the patient.
Inspiratory time measured.
Available only when patient circuit is in leak configuration.
Clinician's Manual 4-3
Monitored Parameters
Table 4-1. Displayed Monitored Parameters (Continued)
Monitored Parameters Display
Minute Volume M Vol
Description
Flow delivered at each breath to the patient is measured by the inspiratory transducer and that measurement is used to calculate minute volume (Vt x Rtot) (the flow transducers do not directly measure volume).
The displayed value is updated at each exhalation.
lnspiratory
Pressure
Pi
Positive End Expiratory
Pressure
Rate
Peak Airway Pressure
PEEP
Rtot
Paw
Highest circuit pressure during each inspiration phase measured with the proximal pressure sensor.
The displayed value is updated at each exhalation.
End exhalation pressure is measured by the proximal pressure sensor.
The displayed value is updated at each inspiration.
Total number of breaths measured per minute.
The displayed value is based on each breath and is updated at each inspiration.
The average peak pressure during the inspiratory phase, measured by each cycle and over the previous 24-hour period.
4.2
Bargraph Display
In the ventilation menu, the highlighted bargraph dynamically shows pressures established
throughout the breath cycle ( Figure 4-6. ).
Figure 4-6. Bargraph Display
4-4
The Pi value reached during a cycle is represented by a line at the top of the bargraph ( Figure 4-
, item 1), which remains shown until the maximum value of the following cycle has been reached.
The PEEP value is represented by a line at the bottom of the bargraph (
, item 2).
Clinician's Manual
Ventilation Report
4.3
Ventilation Report
The Ventilation Report is available in the Preferences menu (see Chapter 7 , “ Operating Procedures
”).
The Ventilation Report updates daily at 8 AM and shows the average readings from the previous
24 hours. See
Figure 4-7. Ventilation Report
Note:
The values shown in the Ventilation Report are reinitialized when the software is updated or the patient hours counter is reset to 0.
The following data are shown in the Ventilation Report:
Vent Time—Ventilation Time
The ventilation duration data are based on the patient counter and shows the total ventilation time in hours and minutes over the previous 24-hour period.
VTI—Inspired Tidal Volume
When ventilating with an exhalation valve, the VTI is the average inspired tidal volume during each ventilation cycle over the previous 24-hour period.
When ventilating in leak mode, the VTI is the average volume delivered by the ventilator during each ventilation cycle over the previous 24-hour period.
Paw—Peak Airway Pressure
The peak airway pressure is the average peak pressure during the inspiratory phase, measured by each cycle and over the previous 24-hour period.
Rate—Respiratory Rate
The respiratory rate is the average of the total respiratory frequency of the patient and the ventilator measured over the previous 24-hour period.
Clinician's Manual 4-5
Monitored Parameters
Leak
When ventilating with a leak configuration circuit, it is the average patient/circuit leak during each cycle and over the past 24-hour period. When ventilating with a single-limb circuit with valve, there is no average leak.
AI—Apnea Index
The apnea index is the average number of apnea events per hour of ventilation. It is based on the
Apnea alarm.
Apnea Ti—Apnea Time
This is the accumulated apnea time over the previous 24-hour period.
Spont Cyc—Spontaneous Cycling
This is the percentage of ventilation cycles initiated by the patient and the ventilator over the previous 24-hour period.
Machine
The total time in hours that the ventilator has been switched on since manufacture.
Patient
The total time in hours and minutes that the current patient has been ventilated.
4-6 Clinician's Manual
5 Alarms and Troubleshooting
WARNING:
Setting Alarm limits to extreme values can cause the ventilator alarms to malfunction.
WARNING:
When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator.
WARNING:
Alarm volume should be adjusted with respect to the ventilator’s operating environment and so that the patient's caretakers can hear the alarms. The audible alarm vents located at the front of the device should never be obstructed. See section
, “
•
The alarms or faults generated by your Puritan Bennett™ 520 Ventilator are classified into two categories:
Ventilation (or utilization) alarms
• Technical faults
Alarms indicate events likely to affect the ventilation in the short term and necessitate rapid intervention (see section
, “ Troubleshooting ” on page 5-14 ).
Some of the ventilator alarms are adjustable, depending on ventilation modes (see Chapter 3 ,
“
”). Automatic, nonadjustable alarms also exist to create a safety net for safer patient ventilation.
Note:
Default alarm setting preferences should be entered prior to using the ventilator.
Note:
Setting any alarm limits to OFF or to extreme high or low values can cause the associated alarm not to activate during ventilation, which reduces its efficacy for monitoring the patient and alerting the caregiver to situations that may require intervention.
Note:
All configurable alarm settings are recorded in the ventilator’s nonvolatile internal memory, and are retained when powering down or in the event of a total loss of power.
5-1
5-2
Alarms and Troubleshooting
Technical faults do not directly affect machine operation. Therefore, the user is not alerted to technical faults. Only authorized and trained technicians may consult the maintenance menu (see the
Puritan Bennett 520 Ventilator service manual).
5.1
Alarm Level of Priority
•
•
The alarm hierarchy for signaling the level of alarm criticality is listed as follows:
Very high priority (VHP): immediate critical situation; ventilation is impossible: Continuous sound signaling / with or without continuous red LED illumination / with or without message / with or without display lighting (it is possible for an alarm condition to occur that may not have both a message and lighting)
High priority (HP): critical situation in the short term; ventilation is potentially compromised:
High speed intermittent sound signaling / flashing red LED illumination / with message / with display lighting
• Medium priority (MP): critical situation in the long term; ventilation is not affected in the short term: Medium speed intermittent sound signaling / flashing yellow LED illumination / with message
/ with display lighting
Note:
There are currently no low priority (LP) alarms.
Note:
If there is no corrective action and if the audible alarm is not inhibited (Audio Paused) or reset (Alarm Reset) within 60 seconds, high priority alarms will sound at the maximum level.
5.2
Alarm Display
•
•
•
During operation, when an alarm is activated, the following events occur:
One of the red or yellow alarm indicators to the left of the ALARM CONTROL key illuminates and flashes.
An alarm tone sounds.
A message is shown and flashes in reverse video at the bottom of the Ventilation menu or Alarm menu.
Clinician's Manual
Figure 5-1. Alarm Displays
Alarm Display
Ventilation menu
1 Alarm Control key
Alarm menu
1 Alarm messages
Note:
There are currently no low priority (LP) alarms.
When an alarm is triggered, if the current menu shown is not the Ventilation parameters or Alarm menu, the display automatically switches to one of these menus to show the alarm message.
In the event several alarms are activated at the same time, the highest priority audible and visual alarm is highlighted; however, all active messages are shown, in the sequence in which they occurred.
Clinician's Manual 5-3
Alarms and Troubleshooting
5.3
Alarm Log Menu
All alarms are recorded in the ventilator’s nonvolatile internal memory at the time of activation, and are retained when powering down or in the event of a total loss of power.
The Alarm Logs menu is used to show the last eight alarms activated, along with their date and time of activation.
To access the Alarm Log menu, do the following:
1.
Press the MENU key to access the Alarm setting menu (if this is not the menu currently shown).
2.
Press the DOWN key until the cursor is on the Alarm Logs line at the bottom of the page. The screen
appears as shown in Figure 5-2.
Figure 5-2. Accessing Alarm Log Menu
3.
Press the ENTER key. The Alarm Log screen is shown.
Figure 5-3. Alarm Log Screen
5-4
Note:
When no alarm has been activated, NO DATA is shown on the screen (see Figure 5-4. ).
Clinician's Manual
Pausing the Audible Portion of Alarms
Figure 5-4. Alarm Log Screen when No Alarm Activated
For more information on the User’s clear alerts line, see section
” on page
To dismiss the Alarm Log screen manually:
Press the ENTER key when the cursor is on the Back line.
•
The Alarm Log screen is dismissed automatically:
After 15 seconds if no keyboard action is detected
• When a high priority alarm is triggered
Note:
Only qualified service personnel may access all alarms and events recorded by the ventilator. Qualified personnel should see the Puritan Bennett 520 Ventilator service manual for further information.
5.4
Pausing the Audible Portion of Alarms
You may pause the audible portion of alarms for 60 seconds at a time.
To pause the audible portion of activated alarms:
•
Press the ALARM CONTROL key.
The audible portion of all activated alarms is paused.
• The visual portions (light indicator and message) of activated alarms remain visible.
The Audio Paused symbol is shown at the top right of the screen while the audio pause function is active.
Clinician's Manual 5-5
Alarms and Troubleshooting
Figure 5-5. Pausing the Audible Portion of Alarms
5-6
If several alarms are activated at the same time, pressing the ALARM CONTROL key affects all current alarms.
•
The audible portion of activated alarms is automatically reactivated if the following occurs:
After 60 seconds, if the cause or causes of the alarm or alarms persist
• Whenever a new alarm is activated
Note:
If a key is stuck or held down for 45 seconds, a keypad alarm will occur.
5.5
Pausing/Resetting Alarms
WARNING:
When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator.
WARNING:
Alarm volume should be adjusted with respect to the ventilator’s operating environment and so that the patient's caretakers can hear the alarms. The audible alarm vents located at the front of the device should never be obstructed. See section
, “
Some alarms are not automatically canceled when the condition causing the alarm clears (for example, HIGH PRESSURE). Some alarms can be paused manually even if the cause or causes of their activation remain.
To manually pause an alarm, proceed as follows:
Press the ALARM CONTROL key twice.
Clinician's Manual
Reactivating Alarms
•
•
The alarm is paused until the alarm condition is corrected and the condition reoccurs; the audible portion, light indicator, and message are all halted (for the alarms that can be paused manually).
The Alarm Paused symbol is shown at the top right of the Ventilation and Alarms screens. See
Figure 5-6. Manually Pausing Alarms
When no other alarms are currently activated, the last alarm canceled is shown continuously in the alarm message window in the Alarms menu, along with the date and time of its activation.
The High Pressure alarm must be manually reset. See section 5.7
, “
” on page
To manually reset the High Pressure alarm, proceed as follows:
Press the ALARM CONTROL key twice. The visual alarms will be reset.
5.6
Reactivating Alarms
Alarms that have been paused and whose activation conditions continue to exist can be reactivated.
To reactivate alarms, proceed as follows:
1.
Press the MENU key to access the Alarm Setting menu, if this is not the menu currently shown.
2.
Press the DOWN key to position the cursor on the Alarm Logs line, if this is not already the case. See
Clinician's Manual 5-7
Alarms and Troubleshooting
Figure 5-7. Reactivating Alarms
3.
Press the ENTER key, to confirm access to the Alarm Log menu.
4.
Press the UP key to position the cursor on the User’s clear alerts line. See
Figure 5-8. Alarm Log
5-8
•
•
•
•
•
•
5.
Press the ENTER key for at least 3 seconds. The following events occur:
A “beep” sounds.
An audible alarm sounds.
An alarm indicator illuminates.
The messages of all active alarms are shown in a loop in the Ventilation and Alarm menus.
The Audio Paused symbol disappears (if it was shown).
The Alarm Paused symbol disappears.
Clinician's Manual
Overview of Alarms
5.7
Overview of Alarms
Note:
The message *IF PERSISTS RESTART/SRVC will occur only if the alarm condition continues for longer than
30 seconds.
Note:
If the message *IF PERSISTS RESTART/SRVC occurs, restart the ventilator. If the alarm condition is not cleared, call a service representative.
For corrective actions and troubleshooting of the following alarms, see
Table 5-2. , Alarms and Corrective Actions .
Table 5-1. Overview of Alarms
Cause/ventilator response Alarm message Priority Audio
Paused available
Alarm Paused available
AC POWER
DISCONNECTION
APNEA
BATTERY FAULT1
RESTART/SRVC
BATTERY FAULT2
RESTART/SRVC
BUZZER FAULT1
RESTART/SRVC
Cut-off of the AC (mains) power supply.
Alarm activation occurs:
• After 5 seconds if ventilation is stopped
• At the start of a ventilation cycle when ventilation is in progress.
Consequence: the ventilator will automatically switch to external DC power supply if present; if not, to the internal battery.
No inspiratory trigger detected by the ventilator after the apnea time set in PSV and CPAP modes.
Automatically clears itself after two successive patient breaths.
Ventilator has detected an internal battery fault.
Consequence: the internal battery is disabled from use.
No internal battery detected.
Defective operation of the buzzers.
MP
MP
MP
MP
Yes
Yes
Yes
Yes
Yes
Yes (except for
CPAP)
Yes
No
MP Yes No
BUZZER FAULT2
RESTART/SRVC
BUZZER FAULT3
RESTART/SRVC
Failure detected in the very high priority buzzer.
Consequence: no audible alarm in case of POWER
SUPPLY LOSS alarm.
Battery charge failure due to incorrect voltage.
Contact your service representative for assistance.
MP
HP
Yes
Yes
Yes
No
Clinician's Manual 5-9
Alarms and Troubleshooting
Alarm message
Table 5-1. Overview of Alarms (Continued)
Cause/ventilator response Priority
BUZZER LOW BATTERY
CHECK EXH VALVE*
*IF PERSISTS RESTART/
SRVC
Buzzer battery failure. The battery buzzer voltage is too low.
Internal technical problem that prevents the battery from sounding the POWER SUPPLY LOSS alarm.
CHECK BATTERY CHARGE
IF PERSISTS RESTART/
SRVC
Internal battery charging failure.
Consequence: charging of the internal battery impossible.
Inspired tidal volume during exhalation <20% of inspired tidal volume and inspired tidal volume
>20 mL.
Exhalation valve obstructed.
CHECK EXH VALVE
PRESSURE
Internal ventilation fault related to exhalation valve detection sensor (pressure sensor).
CHECK PROXIMAL LINE1*
*IF PERSISTS RESTART/
SRVC
Loss of signal from the proximal pressure sensor.
Consequence: switch to internal pressure sensor for the pressure measurement.
Alarm activation occurs:
In the event of signal loss (1): After one ventilation cycle or
In the event of signal loss (2) and after the 17th breath cycle: After 17 seconds for P A/C mode, or after the maximum time between 17 seconds and
Apnea time + 4 seconds for CPAP and PSV mode.
CHECK REMOTE ALARM Failure of ventilator remote alarm relay circuit.
CHECK SETTINGS
Alarm activation occurs:
• Systematically after software versions have changed.
• Loss of memorized parameters.
Consequence:
• Locking Key disabled
• Out-of-range settings are replaced by their default values
CONNECT VALVE OR
CHANGE PRESS
CONTROLLED CYCLES
COOLING FAN RESTART/
SRVC
DC POWER
DISCONNECTION
No exhalation valve connected with PEEP set to less than 4 mbar or Pi set to more than 30 mbar when relative pressure is set to OFF.
The ventilator is delivering apnea ventilation at set back up rate.
Ventilator cooling fan operating speed not suited to the internal ambient temperature of the device.
Cut-off of the external DC power supply.
Consequence: switch-over to the internal battery.
MP
MP
HP
MP
MP
MP
HP
N/A
MP
MP
Audio
Paused available
Yes
Yes
Yes
HP Yes
Yes
Yes
Yes
Yes
N/A
Yes
Yes
Alarm Paused available
Yes
No
No
Yes
No
Yes
Yes
No
N/A
Yes
Yes
5-10 Clinician's Manual
Overview of Alarms
Alarm message
Table 5-1. Overview of Alarms (Continued)
Cause/ventilator response Priority
DEVICE FAULT3 RESTART/
SRVC
Failure in the 24 V power supply.
DEVICE FAULT5 RESTART/
SRVC
Detection of a fault in the electrical power supply system.
Alarm activation occurs:
Once the ventilator is on for at least 3 seconds, and a power supply fault is detected for at least 5 seconds thereafter.
Consequence: the internal battery capacity is not shown beside the battery symbol.
DEVICE FAULT7 RESTART/
SRVC
Detection of a fault in internal voltage measurement.
DEVICE FAULT9 RESTART/
SRVC
POST RAM Error. RAM read/write does not match memory setting.
DEVICE FAULT10
RESTART/SRVC
DEVICE FAULT11
RESTART/SRVC
DEVICE FAULT12
RESTART/SRVC
DEVICE FAULT13
RESTART/SRVC
POST FLASH checksum error. Startup FLASH computed checksum does not match memory setting.
POST EEPROM Error. Startup EEPROM does not match memory setting.
POST reference voltage error. 5V or 10V reference voltage error.
Software version error.
EMPTY BATTERY
Internal battery capacity <10 minutes or 3%.
(battery voltage <22.5 V)
Consequence: ventilation comes to a halt.
Battery temperature out of tolerance.
Consequence: battery charging stops.
HIGH / LOW BATTERY
TEMP*
*IF PERSISTS RESTART/
SRVC
HIGH INT TEMP COOL
VENT*
*IF PERSISTS RESTART/
SRVC
Device internal ambient temperature out of tolerance range.
HIGH LEAKAGE
The leak estimated by the ventilator exceeds the
Max leak alarm threshold.
HP
MP
MP
MP
MP
Audio
Paused available
Yes
Yes
HP
VHP
VHP
VHP
VHP
VHP
HP No
Yes
No
No
No
No
No
Yes
Yes
Yes
Alarm Paused available
No
Yes
Yes
Yes
No
No
No
No
No
No
No
No
Clinician's Manual 5-11
Alarms and Troubleshooting
Alarm message
Table 5-1. Overview of Alarms (Continued)
Cause/ventilator response Priority Audio
Paused available
HIGH PRESSURE
• In PSV, CPAP, or P A/C modes, if inspiratory pressure is higher than (P Support or P Control + PEEP)
+ 5 mbar up to 29 mbar or + 10 mbar over
30 mbar during three consecutive cycles.
or
• In PSV or CPAP mode and P Support is set to off, if inspiratory pressure is higher than PEEP + 10 mbar during three consecutive cycles.
Alarm activation occurs:
• After three consecutive breaths.
Consequence:
• Switch to exhalation phase.
HP
Note:
When alarm condition clears, alarm priority indicator must be manually reset by pressing the key.
HIGH RATE
HIGH VTI
Inspired tidal volume greater than Max VTI set during three consecutive breaths in PSV, CPAP, and
P A/C modes.
Alarm activation occurs:
• After three consecutive breaths.
INTENTIONAL VENT STOP
Ventilation has been stopped voluntarily by the caregiver or patient.
Keyboard key held down for more than 45 seconds.
KEYPAD FAULT RESTART/
SRVC*
*IF PERSISTS RESTART/
SRVC
LOW BATTERY
Rate measured greater than Max Rtot set during three consecutive breaths.
Alarm activation occurs:
• After three consecutive breaths.
LOW VTI
NO PROXIMAL LINE2*
*IF PERSISTS RESTART/
SRVC
OCCLUSION CHECK
CIRCUIT*
*IF PERSISTS RESTART/
SRVC
Internal battery capacity <30 minutes or 8%.
Inspired tidal volume less than Min VTI set during three consecutive breaths in PSV, CPAP, and P A/C modes.
Alarm activation occurs:
• After three consecutive breaths.
Proximal pressure <0.6 mbar for 100 ms during inspiration phase of third breath cycle.
Ventilator response: Switch to internal pressure sensor for pressure measurement.
Occurs in VALVE configuration when the tidal volume is measured below 20 mL during three consecutive breaths for PSV, CPAP, and PA/C modes.
Alarm activation occurs after three consecutive breaths; if tidal volume is less than 20 mL.
MP
HP
Yes
Yes
HP Yes
HP
HP No
MP
MP
Yes
Yes
Yes
Yes
HP Yes
Alarm Paused available
No
(The visual portion of the alarm may be paused)
No
No
Yes
No
No
No
No
No
5-12 Clinician's Manual
Overview of Alarms
Alarm message
Table 5-1. Overview of Alarms (Continued)
Cause/ventilator response Priority
OCCLUSION CHECK
CIRCUIT
PATIENT
DISCONNECTION*
*IF PERSISTS RESTART/
SRVC
REMOVE VALVE
CPAP MODE
REMOVE VALVE OR
CHANGE PRES
SOFTWARE VERSION
ERROR
Occurs in leak configuration when the leak level is not sufficient to flush the CO
2 from patient exhalation. The built-in leak in the mask may be obstructed.
The built-in leak for the mask is not sufficient for the settings.
Alarm activation occurs if conditions remain for the maximum time between:
• Disconnection time and 60/R-Rate in P A/C mode
• Disconnection time and (Apnea time +2 sec) in
CPAP and PSV mode
If the flow is greater than 130 lpm during the inspiratory phase.
POWER FAULT RESTART/
SRVC
POWER SUPPLY LOSS
(no message)
In PSV, CPAP, and P A/C modes if patient pressure is lower than (P Support + PEEP) - 20% or (Pi + PEEP)
- 20%.
Detection of a fault in the electrical power supply system.
1. Electrical power supply to the machine is interrupted with the I/O switch when ventilation is in progress or
2. Battery fully discharged when it was the only source of power to the ventilator.
Consequence: ventilation stops immediately. Ventilation restarts immediately when the switch is pressed in case 1 or after restoration of the AC or
DC supply in case 2.
PRES SENS FLT1 RESTART/
SRVC
Faulty internal pressure sensor signal.
Alarm activation occurs:
• After 15 seconds.
PROX SENS FLT2
RESTART/SRVC
Faulty proximal pressure sensor signal.
Alarm activation occurs:
• After 15 seconds.
The ventilation settings are not compatible with the type of patient circuit used.
Remove exhalation valve to start CPAP ventilation.
The ventilation settings are not compatible with the type of patient circuit used.
With a valve circuit, the difference between Pi and
PEEP should not be less than 5 mbar.
Detection of a wrong software version.
HP
MP
VHP
MP
HP
HP
N/A
Audio
Paused available
Yes
HP Yes
Yes
No—Alarm cancel only
HP Yes
Yes
Yes
Yes
N/A
Alarm Paused available
No
No
Yes
No—Alarm cancel only
No
Yes
No
No
N/A
Clinician's Manual 5-13
Alarms and Troubleshooting
Alarm message
Table 5-1. Overview of Alarms (Continued)
Cause/ventilator response Priority Audio
Paused available
Alarm Paused available
HP No No
TURB OVERHEAT
RESTART/SRVC
UNKNOWN BATTERY
Turbine speed too low and temperature too high.
Consequence: ventilation stops immediately and
O
2
supply stops.
The internal battery is not recognized as a Puritan
Bennett product battery or is not the correct battery for the Puritan Bennett 520 Ventilator.
MP Yes No
5.8
Troubleshooting
WARNING:
This manual tells you how to respond to ventilator alarms, but it does NOT tell you how to respond to the patient.
WARNING:
To ensure proper servicing and avoid the possibility of physical injury to personnel or damage to the ventilator, only personnel authorized and qualified by Covidien should attempt to service or make authorized modifications to the Puritan Bennett™ 520 Ventilator.
5.8.1
Alarms
offers a guide to the most likely ventilator alarms, possible reasons for the alarms, and corrective actions.
WARNING:
Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only personnel authorized and qualified by Covidien should repair, open or service the ventilator.
WARNING:
When an alarm condition is triggered, or there is evidence of a patient-ventilator fault or problem, examine the patient first before examining the ventilator.
Note:
The ventilator screen must be unlocked before setting and parameters can be changed.
5-14 Clinician's Manual
Troubleshooting
Alarm message or symptom
Table 5-2. Alarms and Corrective Actions
Possible reason for the alarm event Corrective action
AC POWER
DISCONNECTION
APNEA
BATTERY FAULT1
RESTART/SRVC
BATTERY FAULT2
RESTART/SRVC
BUZZER FAULT1
RESTART/SRVC
BUZZER FAULT2
RESTART/SRVC
BUZZER FAULT3
RESTART/SRVC
BUZZER LOWBATTERY
CHECK BATTERY
CHARGE
AC (“mains”) power source cut off.
Cancel the alarm, and then check the supply cable and the effective availability of a voltage on the AC power (“mains”) port.
Starting with 12–30 VDC external power supply.
Cancel the alarm.
Current-limiting fuse of the device blown.
Patient apnea.
Replace the ventilator and call for the maintenance technician.
Patient’s breathing effort less than the sensitivity control setting.
Ensure the patient is breathing and adjust the inspiratory setting appropriately based on patient’s respiratory needs.
Examine the patient for breathing effort and stimulate if necessary.
If patient status has changed, adjust the ventilator settings based on patient’s respiratory needs.
Defective sensors.
Battery problem that prevents it from operating.
Internal battery missing or not detected.
Have a qualified technician replace the defective component or components and call your customer service representative.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Defective operation of the buzzers.
Consequence: no audible tone when an alarm is activated.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Internal technical problem that prevents the very high priority “POWER SUPPLY LOSS” alarm from triggering.
Ensure that the protective cover over the I/O switch located on the rear of the device is intact and functioning properly.
This cover helps prevent accidental pressing of the I/O switch and stoppage of the ventilation.
Ensure that the device is stabilized.
Call your customer service representative.
Internal technical problem that prevents the battery from correctly charging.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Connect the ventilator to an AC power source and power on using the I/O switch located on the rear of the ventilator.
Internal technical problem that prevents the battery warning buzzer from sounding
POWER SUPPLY LOSS alarm.
Allow the ventilator to charge for a minimum of15 minutes and up to 2 hours.
Battery charging impossible.
If alarm persists, restart ventilator to see if alarm clears. If not, contact Covidien or a local Covidien representative.
Do not disconnect the ventilator from the AC power supply.
Ensure that the power cable is installed according to the
instructions in Chapter 6 , “ Installation and Assembly
,” so that the power cable cannot be involuntarily disconnected.
In the event the internal battery capacity is low, use an alternate device to ventilate the patient.
Call your customer service representative.
Clinician's Manual 5-15
Alarms and Troubleshooting
Alarm message or symptom
Table 5-2. Alarms and Corrective Actions (Continued)
Possible reason for the alarm event Corrective action
CHECK EXH VALVE*
*IF PERSISTS
RESTART/SRVC
CHECK EXH VALVE
PRESSURE
Obstruction or abnormal damage of the exhalation valve.
No connection of the proximal pressure tube when ventilation starts.
Clean or replace the exhalation valve, its control tube, or both.
Excessive moisture in the exhalation valve.
Defective connection or defective exhalation valve tubing.
Defective inspiratory flow sensor.
Remove moisture from exhalation valve.
Verify exhalation valve is seated properly.
Reduce temperature of the humidifier.
Reconnect the valve or replace the exhalation valve, the exhalation valve pilot pressure tube, or both.
Have a qualified technician replace the defective component or components and call your customer service representative.
The exhalation valve may not be detected by the ventilator when ventilation is started.
The exhalation valve may be falsely detected when ventilation is started.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Reconnect the proximal pressure line.
CHECK PROXIMAL LINE1*
*IF PERSISTS
RESTART/SRVC
Proximal pressure line disconnected or obstructed.
Defective proximal pressure sensor or internal leak of the machine.
Reconnect the connection line or replace it if obstructed.
Check for moisture or occlusion of the proximal line.
Reduce humidifier temperature.
Switch to a heated wire circuit.
Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component or components and call your customer service representative.
Nurse call or remote alarm system is disconnected.
Connect the nurse call or remote alarm cable to the ventilator.
CHECK REMOTE ALARM
CHECK SETTINGS
Relay control voltage problem.
Loss of memorized parameters.
Software versions have changed.
Carefully monitor the patient to detect possible alarm triggering and call for the maintenance technician.
Check and adjust the prescribed parameters, if necessary.
Check and adjust the prescribed parameters, if necessary.
CONNECT VALVE
OR CHANGE PRESS
CONTROLLED CYCLES
COOLING FAN
RESTART/SRVC
The ventilation settings are not compatible with the type of patient circuit used.
No exhalation valve connected with PEEP set to less than 4 mbar or
Pi set to more than 30 mbar when relative pressure is set to OFF.
Connect exhalation valve.
Decrease Pi to less than 30 mbar in absolute pressure.
Increase PEEP to more than 3 mbar.
Note:
Always consult the clinician before changing
PEEP, pressure, or Rate settings.
The ventilator is delivering apnea ventilation at set back up rate.
Check that the patient circuit is correctly attached and the patient is correctly ventilated.
Operating speed of the cooling fan not properly adjusted for the internal ambient temperature of the device.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
5-16 Clinician's Manual
Troubleshooting
Alarm message or symptom
Table 5-2. Alarms and Corrective Actions (Continued)
Possible reason for the alarm event Corrective action
DC POWER
DISCONNECTION
DEVICE FAULT3
IF PERSISTS RESTART/
SRVC
DEVICE FAULT5
IF PERSISTS RESTART/
SRVC
DEVICE FAULT7
IF PERSISTS RESTART/
SRVC
DEVICE FAULT9
IF PERSISTS RESTART/
SRVC
DEVICE FAULT10
IF PERSISTS RESTART/
SRVC
DEVICE FAULT11
IF PERSISTS RESTART/
SRVC
DEVICE FAULT12
IF PERSISTS RESTART/
SRVC
DEVICE FAULT13
IF PERSISTS RESTART/
SRVC
EMPTY BATTERY
12–30 VDC power supply cut off when there is no AC (“mains”) power supply.
Cancel the alarm, and then check the supply wiring and the effective availability of voltage on the external source.
Ventilator’s current-limiting fuse blown.
Replace the ventilator and call your customer service representative.
24 V supply failure.
Internal problem in the electrical power supply.
Internal technical problem.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
POST RAM error. RAM read/write does not match memory setting.
If patient has been disconnected, reconnect patient to reset the fault.
If persists, restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
POST FLASH checksum error. Startup FLASH computed checksum does not match memory setting.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
POST EEPROM error. Startup EEPROM does not match memory setting.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
POST reference voltage error. 5 V or 10 V reference voltage error.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Incorrect software version detected.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Internal battery capacity is less than
10 minutes (or 3%)—battery operation overextended.
Reconnect the device to an AC power outlet, connect it to an external DC power source, or replace the battery.
Reminder: the internal battery can be charged only when the ventilator connected to an AC power supply.
Clinician's Manual 5-17
Alarms and Troubleshooting
Alarm message or symptom
HIGH INT TEMP
COOL VENT
Table 5-2. Alarms and Corrective Actions (Continued)
Possible reason for the alarm event Corrective action
Note:
Ensure that you are operating the ventilator within the proper temperature range (see Appendix
“
”).
Put the device in a warmer environment (if the ambient temperature is too low) or in a cooler environment (if the ambient temperature is too high). For example, ensure the ventilator is not in direct sunlight or next to an air conditioning vent.
WARNING:
Internal ambient temperature of the device out of the tolerance ranges.
In case of operation in a high ambient temperature, handle the ventilator with care; some portions of the device may have high surface temperatures.
WARNING:
In the case of high ambient temperatures, it may take a significant period of time to cool the internal temperature of the ventilator to the proper operating range. To avoid injury to the patient, ensure that the air inspired by the patient does not exceed 41°C (106°F). If in doubt, replace the ventilator.
Defective internal temperature probe or any other technical anomaly.
Replace the ventilator and call your customer service representative.
5-18 Clinician's Manual
Troubleshooting
Table 5-2. Alarms and Corrective Actions (Continued)
Possible reason for the alarm event Corrective action Alarm message or symptom
HIGH/LOW BATTERY
TEMP*
*IF PERSISTS RESTART/
SRVC
HIGH LEAKAGE
Caution:
Battery temperature out of the tolerance ranges.
Defective internal temperature probe or any other technical anomaly inside the battery.
Ensure that ventilator is being used according to the operating instructions found in
Appendix B , “ Specifications .”
If the ambient temperature is too low, place the device in a warmer environment.
If the ambient temperature is too high, place the ventilator in a cooler environment.
For example, ensure the ventilator is not in direct sunlight or next to an air conditioning vent. The temperature fault alarm does not interfere with the operation of the ventilator.
WARNING:
In case of operation in a high ambient temperature, handle the ventilator with care; some portions of the device may have high surface temperatures.
Restart ventilator to see if alarm clears. if the alarm message persists, please contact technical services.
Caution:
Do not attempt to charge a defective battery; such a battery cannot be charged.
The leak estimated by the ventilator exceeds the Max leak alarm threshold.
Readjust mask to reduce leakage or increase the alarm settings.
Clinician's Manual 5-19
Alarms and Troubleshooting
Alarm message or symptom
HIGH VTI
HIGH PRESSURE
HIGH RATE
INTENTIONAL
VENT STOP
Table 5-2. Alarms and Corrective Actions (Continued)
Possible reason for the alarm event Corrective action
Note:
Adjustment of the Max VTI level too low (for
PSV, CPAP, and P A/C modes).
Always consult the clinician before changing
PEEP, pressure, or Rate settings.
Modify the Max VTI level.
Note:
Adjustment of the pressure level too high for the volume required (for PSV, CPAP, and P A/
C modes).
Always consult the clinician before changing
PEEP, pressure, or Rate settings.
Modify the pressure level.
A leak in the patient circuit causing increased bias flow.
Inappropriate patient circuit.
Defective flow sensor or internal leak in the machine.
Airway obstruction.
Proximal pressure tube or patient circuit obstructed.
Coughing or other high-flow exhalation efforts.
Check and properly connect the patient circuit.
Replace the patient circuit.
Have a qualified technician replace the defective component or components and call your customer service representative.
Check patient’s trachea and clear the obstruction. If the filter is obstructed, replace the filter.
Clean the proximal pressure tube or the patient circuit or replace them.
Treat patient’s cough.
Pause the audible alarm, if necessary.
Patient inspiratory resistance or compliance changes.
Have physician determine if ventilator settings are appropriate for the patient.
Defective internal circuits of the machine or pressure sensor.
Replace the ventilator and call your customer service representative.
Adjustment of the Max Rtot level too low.
Adjustment of the I Sens level too low.
Readjust Max Rtot.
Adjust I Sens according to the patient.
Patient hyperventilating.
Pause the audible alarm and call for a medical team if the symptoms persist.
Check for autocycling and adjust inspiratory sensitivity, manage leaks, or drain condensation from patient circuit.
Defective inspiratory flow sensor.
Have a qualified technician replace the defective component or components and call your customer service representative.
The user/caregiver has stopped ventilation
Check that the ventilation was switched off on purpose. using the VENTILATION ON/OFF
This alarm can be deactivated. See section 7.2.2
, “
Ventilation is in standby.
5-20 Clinician's Manual
Troubleshooting
Alarm message or symptom
Table 5-2. Alarms and Corrective Actions (Continued)
Possible reason for the alarm event Corrective action
KEYPAD FAULT
RESTART/SRVC
LOW BATTERY
LOW VTI
NO PROXIMAL LINE2
PATIENT
DISCONNECTION
*IF PERSISTS RESTART/
SRVC
Pressing a key for more than 45 seconds.
Press and release keys in the normal, prescribed manner. Do not press keys for 45 seconds or more.
A key on the keyboard is stuck.
If unsuccessful in releasing the stuck key or keys, restart ventilator to see if alarm clears. If not, replace the device and call your customer service representative if the situation persists.
Internal battery capacity is less than
30 minutes (or 8%)—battery operation overextended.
Immediately connect the ventilator to an AC power outlet, or connect it to an external DC power source.
Reminder: the internal battery can be charged only when the ventilator is connected to an AC power supply.
Adjustment of the Min VTI level too high (for
PSV, CPAP, and P A/C modes).
Modify the Min VTI level.
Adjustment of the pressure level not enough to reach the volume required (for
PSV, CPAP, and P A/C modes).
Modify the pressure level according to the physician’s prescription.
Patient circuit obstructed or disconnected.
Clean, unblock, or reconnect the patient circuit.
Inappropriate patient circuit.
Defective flow sensor or internal leak in the machine.
Replace the patient circuit.
Check patient, replace the device, and call your technician or customer service representative.
The proximal pressure line is disconnected. Connect proximal pressure line.
Leak or loose connection in the patient circuit.
Circuit disconnection from patient or ventilator.
Inspiratory flow exceeds 130 LPM.
Check the patient circuit connections to the ventilator; examine all connections for leakage and tightness.
Replace the patient circuit if necessary.
Adjust Apnea alarm setting.
Inappropriate patient circuit.
Replace the patient circuit.
Defective internal circuits of the machine or pressure sensor.
Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component or components or call your customer service representative.
OCCLUSION CHECK
CIRCUIT
Patient circuit obstructed.
Clean, unblock, or properly connect the patient circuit.
*IF PERSISTS RESTART/
SRVC
OCCLUSION CHECK
CIRCUIT
POWER FAULT RESTART/
SRVC
A nonvented configuration is being used or the built-in leak in the mask or in the circuit may be obstructed or insufficient for the settings. Note that a high respiratory or backup rate may not sufficiently flush out CO
2 in some vented pediatric masks.
Replace the nonvented circuit with a vented one. Clean, unblock the mask or the circuit of the vented system or switch to a vented system with a larger leak configuration.
Try to reduce patient’s backup rate if possible.
Internal problem in the electrical power supply.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Clinician's Manual 5-21
Alarms and Troubleshooting
Alarm message or symptom
Table 5-2. Alarms and Corrective Actions (Continued)
Possible reason for the alarm event Corrective action
POWER SUPPLY LOSS
(without message)
PRES SENS FLT1
RESTART/SRVC
PROX SENS FLT2
RESTART/SRVC
REMOVE VALVE OR
CHANGE PRES
REMOVE VALVE
CPAP MODE
SOFTWARE VERSION
ERROR
Electrical power supply cut off by the main switch when ventilation is in progress.
The internal battery that supplies the ventilator is entirely discharged.
Defective internal pressure sensor.
Defective proximal pressure sensor or internal leak of the machine.
The ventilation settings are not compatible with the type of patient circuit used.
Press the I/O switch to restore electrical power to the ventilator and allow ventilation to continue.
To stop ventilation, press and hold the VENTILATION ON/OFF key for 3 seconds. Press the VENTILATION ON/OFF key again
to confirm stop. See Chapter 7
, “
Immediately connect the ventilator to an AC power outlet or an external DC power source; otherwise, use an alternate device to ventilate the patient.
Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component or components and call your customer service representative.
Restart ventilator to see if alarm clears. If not, have a qualified technician replace the defective component or components and call your customer service representative.
Remove exhalation valve to start ventilation with less than 5 mbar of difference between PEEP and Pi or increase the difference between PEEP and Pi to a minimum of 5 mbar.
The ventilation settings are not compatible with the type of patient circuit used.
Remove exhalation valve to start CPAP ventilation.
Incorrect software version detected.
TURB OVERHEAT
RESTART/SRVC
UNKNOWN BATTERY
Turbine overheated because of blockage during operation.
Internal battery not recognized as a
Puritan Bennett product battery or the battery is not intended for the Puritan
Bennett 520 Ventilator.
Call your customer service representative.
Ensure lateral and front openings are not obstructed.
Check air inlet filter.
Restart ventilator to see if alarm clears. If not, replace the ventilator and call your customer service representative.
Switch to a 2400 MAh battery intended for the Puritan
Bennett 520 Ventilator or call your customer service representative.
5-22 Clinician's Manual
Troubleshooting
5.8.2
Additional Troubleshooting
Table 5-3. provides other possible ventilator problems, causes, and corrective actions.
WARNING:
If the device is damaged, its external housing is not correctly closed, or it behaves in a way that is not described in this manual (excessive noise, heat emission, unusual odor, alarms not triggered during the start-up procedure), the oxygen and power supplies should be disconnected and use of the device stopped immediately.
WARNING:
If you cannot determine the cause of a problem with your ventilator, contact your equipment supplier. Do not use the ventilator until the problem has been corrected.
Note:
Buzzer and battery alarms may occur when the unit is first turned on after the internal battery has been completely drained. Connect to an AC power source and recycle power.
Conditions
Table 5-3. Additional Troubleshooting and Corrective Actions
Possible causes
The screen backlight never switches off during ventilation
Backlight set to YES in Preferences menu.
Corrective actions
Set Backlight to OFF in Preferences menu (see section
, “ Preferences Menu Parameters ”).
Alarm sound level too low or too high
Poor visibility of the displays
Unusual display on the screen
Adjustment of the alarm sound level is incompatible with the patient’s environment.
Contrast adjustment is incompatible with the luminosity of the environment.
Problem with the display unit.
Readjust sound level (see section 7.3
,
“
”).
Readjust contrast (see section
,
“
”).
Adjust contrast or call your customer service representative if the problem persists.
Ensure that the ventilator is not exposed to direct radiation from the sun.
The ventilator does not operate after pressing
I/O switch
No external power source and the internal battery is completely discharged.
Connect the ventilator to the AC power source.
Light noise
Whistling noise or vibrations
Excessive heat emitted
Condensation inside the device
Turbine noise.
Filter, the turbine silencer, or both have deteriorated.
Replace the ventilator and call your customer service representative.
Replace the ventilator and call your customer service representative.
Valve membranes damaged.
Obstruction of main or secondary air inlets of the casings.
Liquid entered the device.
Replace the ventilator and call your customer service representative.
Remove obstructions from all blocked ventilator air inlets and outlets.
Replace the ventilator and call your customer service representative.
Clinician's Manual 5-23
Alarms and Troubleshooting
Page Left Intentionally Blank
5-24 Clinician's Manual
6 Installation and Assembly
WARNING:
Before operating the ventilator, read, understand, and strictly follow the information contained in Chapter
WARNING:
The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent.
WARNING:
A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection. The use of a bacterial filter at the ventilator’s outlet is highly recommended. Refer to Chapter
.”
6.1
Installing the Ventilator
•
To install your Puritan Bennett™ 520 Ventilator:
Choose an area where air can circulate freely. Avoid proximity to loose fabrics, such as curtains, and direct exposure to sunlight.
• Set the ventilator on a flat and stable surface so that its feet are all in contact with the surface. The ventilator may operate in any position, provided that the air inlets are not obstructed and the device cannot fall and possibly cause damage, personal injury, or both.
WARNING:
The operator should connect the ventilator to an AC power source whenever available, for safer operation.
WARNING:
To ensure correct and lasting operation of the ventilator, ensure that its air circulation holes
(main inlet or cooling) are never obstructed. Place the device in an area where air can freely circulate around the ventilator and avoid installing it near floating fabrics, such as curtains.
6-1
6-2
Installation and Assembly
WARNING:
Do not place the ventilator in a position where a child can reach it or in any position that might cause it to fall on the patient or someone else.
WARNING:
Ensure that the ventilator’s immediate surroundings allow for the proper operational connection of the device without folding, pinching, or damaging any of the required cables or tubes, and that the connection of the patient circuit to the patient provides for a secure, comfortable fit.
WARNING:
Do not operate the ventilator in direct sunlight, near heat sources, outdoors, or near installations where liquid may pose a risk without first providing adequate protection for the device.
WARNING:
If the ambient temperature where the device is operated is greater than 35°C (95°F), the flow supplied at the device outlet may exceed 41°C (106°F). This may lead to undesirable side effects for the patient. To avoid injury to the patient move the patient and the ventilator to a cooler location.
WARNING:
To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses.
WARNING:
Never connect your ventilator to an electrical outlet controlled by a wall switch because the power may be inadvertently turned off.
WARNING:
Even if the “INTERNAL BATTERY” charging indicator is off, charging of the battery may sometimes be incomplete if the ambient temperature is above 40°C (104°F) because of the battery’s internal heat safety device.
WARNING:
The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation.
WARNING:
The Puritan Bennett™ 520 Ventilator requires special precautions for electromagnetic compatibility and should be installed and started according to the recommendations found in
, “
Specifications .” In particular, the use of nearby mobile and portable communications
Clinician's Manual
Connecting to External AC Power equipment using radio frequencies, such as mobile telephones or other systems exceeding the
levels set in the IEC/EN 60601-1-2 standard, may affect its operation. Refer to section B.10
,
“ Manufacturer’s Declaration ” on page B-8 .
WARNING:
The ventilator must not use, nor be connected to, any antistatic or electrically conductive hoses, tubing, or conduits.
6.2
Connecting to External AC Power
Any of four power sources—AC power, 12–30 VDC power, internal battery power, or auxiliary DC car adapter (cigarette lighter)—can be used to power the ventilator. However, when AC power is available, the ventilator will automatically select AC power as its operating power source.
WARNING:
The power supply to which the ventilator is connected (both AC and DC) must comply with all current and applicable standards and provide electrical power corresponding to the voltage characteristics inscribed on the rear of the ventilator to ensure correct operation.
WARNING:
Ensure that the AC power cable is in perfect condition and not compressed. The device should not be turned on if the AC power cable is damaged.
WARNING:
Connect the external electrical power source by first connecting the power cable to the ventilator and then to the external power source. Follow the reverse procedure to disconnect the device from electrical power sources.
WARNING:
Never connect your ventilator to an electrical outlet controlled by a wall switch because the power may be inadvertently turned off.
WARNING:
Do not leave power cables lying on the ground where they may pose a hazard.
Clinician's Manual 6-3
Installation and Assembly
To prevent accidental disconnection of the AC power cable, use the power cable holder
(
Figure 6-1. , item 1) that is inserted into the notch ( Figure 6-1. , item 2) of the battery cover.
Figure 6-1. The Power Cable Holder
To secure the AC power cable:
1.
Insert the power cable holder (
Figure 6-2. , item 1) into the notch of the battery cover.
Figure 6-2. Inserting the Power Cable Holder Into the Notch
2.
on the back of the ventilator.
6-4 Clinician's Manual
Figure 6-3. Power Cable Connected to the Ventilator
Connecting to External AC Power
3.
Connect the male end of the AC power cable to the AC power outlet.
•
• The AC POWER indicator on the top left corner of the ventilator illuminates.
The indicator flashes while the battery charges and then turns off when the battery is fully charged
(see
If the AC power cable becomes disconnected or the AC power source fails, an AC POWER DIS-
CONNECTION alarm signals an automatic switch to the external DC power source (if the DC power cable is connected) or to the ventilator’s internal battery.
One of three power indicators, located on the upper-left of the ventilator’s front panel, illuminates to signal, which of the three possible power sources are currently in use by the device (see
Note:
The only time the AC POWER and indicators are illuminated at the same time is when the ventilator is connected to an AC supply and the battery is charging (indicator is flashing).
Clinician's Manual 6-5
Installation and Assembly
Figure 6-4. Power Indicators
6-6
To disconnect the AC power cable:
1.
Disconnect the AC power cable from the AC power outlet.
2.
Disconnect the AC power cable from the ventilator’s AC connector at the rear of the device.
3.
Grasp the AC power cable at the level of the power cable holder and turn the cable clockwise while lifting it upwards and out of the holder.
6.3
Connecting to an External DC Power Source
WARNING:
Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12–30 VDC power source (via the DC power cable) does not enable charging of its internal battery.
WARNING:
When using a car auxiliary adapter (cigarette lighter) ensure the car has been started prior to plugging in the ventilator’s DC adapter.
Note:
An alternative means of ventilation should always be available, particularly when the patient is in transit or away from wall power.
Note:
While using the ventilator on external battery power it is vital that a qualified caregiver (capable of providing necessary corrective actions in the event of alarm conditions) is present.
Note:
When AC power is not available, use an external DC power prior to using internal battery power.
Clinician's Manual
Connecting to an External DC Power Source
To connect the ventilator to an external power source, do the following:
1.
Ensure the car’s engine is started prior to connecting the ventilator.
2.
Connect the DC power cable into the ventilator.
3.
Connect the DC power cable into the car auxiliary adapter.
Note:
Whenever AC power is unavailable, the ventilator can operate from a continuously powered external 12–
30 VDC power source via a DC power cable (
Figure 6-5. , item 1) that connects to the ventilator’s rear panel
DC power input connector (
Figure 6-5. , item 2). The DC power cable is optional; see Appendix
, “
power source.
Figure 6-5. Connecting the Ventilator to an External DC Power Source
WARNING:
Connect the external DC power source by first connecting the power cable to the ventilator and then to the external DC source. Follow the reverse procedure to disconnect the device from the external DC power source.
Clinician's Manual 6-7
Installation and Assembly
To connect the DC power cable to the ventilator:
1.
Line up the red marker dot on the ventilator’s DC power connector with the marker on the DC power cable (
, item 1).
Figure 6-6. Connecting the DC Power Cable to the Ventilator
6-8
1 Align the red markers
(dots or lines) before connecting the cable.
3 To disconnect the DC power cable, slide the locking ring back and pull the cable out
2 Push in to connect the
DC power cable
2.
Push the DC power cable onto the ventilator’s DC power connector ( Figure 6-6. , item 2).
•
•
You will hear a locking “click.”
The DC POWER indicator on the top left corner of the ventilator illuminates (see
).
To disconnect the DC power cable from the ventilator, slide the locking ring
(
Figure 6-6. , item 3) back and pull the plug away from the ventilator’s rear panel to disengage it.
A DC POWER DISCONNECTION alarm signals an automatic switch to the internal battery in case the external DC power source fails or becomes disconnected.
6.4
Patient Circuit
WARNING:
Before opening the packaging for the Patient Circuit, ensure that no damage is evident to the packaging or its contents. Do not use if evidence of damage exists.
Clinician's Manual
Patient Circuit
WARNING:
For pediatric use, ensure that the patient circuit type fits, and, in all respects, is suitable for use with a child. Use a pediatric circuit for patients that weigh under 53 lb. (23 kg). See
Circuits on page H-2 for a list of recommended patient circuits.
WARNING:
The patient circuit should always be positioned to avoid hindering the patient's movements, to prevent accidental disconnection or leakage, and to minimize the risk of patient strangulation.
WARNING:
Ensure that the ventilator’s immediate surroundings allow for the proper operational connection of the device without folding, pinching, or damaging any of the required cables or tubes, and that the connection of the patient circuit to the patient provides for a secure, comfortable fit.
WARNING:
The patient circuit is intended for single use by a single patient and should be changed according to the manufacturer’s recommendations and according to the patient circuit lifetime.
Refer to the instructions for use supplied by the manufacturer of the patient circuit (included with
the ventilator) and Chapter 6 , “ Installation and Assembly .”
WARNING:
After assembling, cleaning, or reassembling the patient circuit, and on a daily basis, inspect the hoses and other components to ensure that there are no cracks or leaks and that all connections are secure.
WARNING:
To ensure proper performance of the ventilator, use a patient circuit recommended by Covidien in
this manual; refer to Chapter 6 , “ Installation and Assembly ” and Appendix
Accessories .” The total specified length of the patient circuit tubing as measured from the
ventilator outlet to the ventilator inlet is 1.1 meters (3.6 feet) to 2.0 meters (6.6 feet). The tubing must conform to all applicable standards and must be fitted with Ø 22 mm terminals that also conform to all applicable standards. Ensure that both the length and the internal volume of the patient circuit are appropriate for the tidal volume: a corrugated tube of Ø 22 mm for adult patients, and a corrugated tube of Ø 15 mm for pediatric patients with a tidal volume lower than
200 ml.
WARNING:
Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration.
Clinician's Manual 6-9
Installation and Assembly
WARNING:
Users must always possess an additional breathing circuit and exhalation valve while using the
Puritan Bennett™ 520 Ventilator.
6.4.1
Choosing the Patient Circuit Type
Be sure to choose the appropriate circuit in the menu preferences; in particular, ensure that Pediatric Circuit Yes/No is set to YES when using a pediatric circuit (see Appendix
H , “ Parts and Accessories ”).
For information regarding validated circuits, visit the SolvIT
SM
Center Knowledge Base at www.medtronic.com/covidien/support/solvit-center-knowledge-base/ or contact your Puritan
Bennett product representative.
6.4.2
Installing the Patient Circuit
The patient circuit is mounted depending on the setup of the circuit used and the accessories used.
The following procedures describe the installation of the patient circuit with a humidifier. To add other accessories, see the installation instructions for the specific accessories used.
To connect a single-limb circuit with an exhalation valve:
See
1.
Inspect the components of the patient circuit for any signs of damage, such as cracks (which might cause leakage). Do not use damaged components to assemble the patient circuit.
2.
Install the bacteria filter (item 3) on the TO PATIENT outlet port, as shown.
3.
Attach one end of the short circuit tubing (item 4) to the bacteria filter (item 3).
4.
Attach the other end of the circuit tubing (item 4) to the inlet port of the humidifier (item 10).
5.
Place a water trap (item 5) between the outlet port of the humidifier and the inlet of the exhalation valve (item 7).
6.
Ensure the exhalation valve (item 7) is placed as close as possible to the patient.
7.
Connect one end of the proximal pressure tubing (item 11) to the proximal pressure port on the exhalation valve (item 8) and the other end onto the ventilator patient pressure port (item 2).
8.
Connect one end of the exhalation valve tubing (item 9) to the exhalation valve port on the exhalation valve (item 7) and the other end onto the ventilator exhalation valve port (item 1).
9.
Place a patient interface to the end of the patient circuit (item 6).
6-10 Clinician's Manual
Figure 6-7. Single-Limb Patient Circuit With Exhalation Valve
Patient Circuit
Note:
Although shown here, the humidifier (item 10), water trap (item 5), and tubes upstream of the single-limb patient circuit are not included with the ventilator. Contact your supplier for more information.
Figure 6-8. Close-up of Exhalation Valve Tube and Proximal Pressure Tube
Figure 6-8. shows details of the connections of the proximal pressure tube (item 1) and the exha-
lation valve tube (item 2).
Clinician's Manual 6-11
Installation and Assembly
To connect a single-limb circuit without an exhalation valve (NIV only):
See
1.
Inspect the components of the patient circuit for any signs of damage, such as cracks (which might cause leakage). Do not use damaged components to assemble the patient circuit.
2.
Install the bacteria filter (item 1) on the TO PATIENT outlet port, as shown.
3.
Attach one end of the short circuit tubing (item 2) to the filter (item 1).
4.
Attach the other end of the circuit tubing (item 2) to the inlet port of the humidifier (item 6).
5.
Place a water trap (item 3) between the outlet port of the humidifier and the patient end of the patient circuit.
6.
Connect one end of the proximal pressure tubing (item 7) as close as possible to the patient at the mask or cannula entry (item 5) and the other end onto the ventilator patient pressure port (item 8).
7.
Place a mouthpiece or vented (NIV) interface to the end of the patient circuit (item 4).
Figure 6-9. Single-Limb Patient Circuit Without Exhalation Valve
6-12
The end of the proximal pressure tube should be connected as close as possible to the patient (at the mouthpiece, mask, or cannula entry, if possible) so that the ventilator can account for all load losses due to the circuit and its potential accessories. If this is not possible, it is best to modify the
PATIENT DISCONNECTION triggering threshold by setting a Max VTI alarm limit for pressure modes. As a reminder: Ensure that the length and the internal volume of the patient circuit are compatible with the tidal volume: ringed tube Ø 22 mm for adults and ringed tube Ø 15 mm for pediatric patients with tidal volumes lower than 200 ml. Use, if necessary, a 22F-15M link on the outlet.
Clinician's Manual
Filters
WARNING:
When using non-invasive ventilation (NIV), without an exhalation valve, use a vented nose or face mask or a non vented mask combined with a leak accessory. When using non-invasive ventilation
(NIV), with an exhalation valve, use a non vented mask.
WARNING:
The level of inspiratory resistance of the circuit and accessories (bacteria filter, humidifier, HMEs, etc.) must be as low as possible. Settings—particularly the PATIENT DISCONNECTION alarm, maximum inspired volume (Max VTI), and minimum inspired volume (Min VTI) settings—must be periodically adjusted according to changes in the patient circuit resistance—especially when filters are replaced. Adding attachments to the ventilator breathing system can cause the pressure during exhalation at the patient connection port to increase.
WARNING:
The exhalation valve must allow rapid discharge of the circuit pressure. Ensure that the exhalation valve is always clean and its evacuation aperture (exhaust port) is never obstructed.
WARNING:
Do not start ventilation until you ensure that the device is suitably assembled, that the air inlet filter is properly installed and is not obstructed, and that there is proper clearance all around the unit. Also ensure that the patient circuit is suitably connected to both the ventilator and the patient and that the patient circuit, including all hoses, is not damaged or obstructed.
WARNING:
Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration.
6.5
Filters
WARNING:
Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If
necessary, replace the filter before the recommended replacement period is over (see Chapter 10
,
“ Routine Maintenance ”). This is particularly important when the ventilator is installed on a
wheelchair, because environmental conditions may cause the filter to become dirty more rapidly.
•
The ventilator features two filter types:
Air inlet filter
Bacteria filter •
Clinician's Manual 6-13
Installation and Assembly
Air Inlet Filter
Consisting of foam and fine particle filter media and located at the rear of the ventilator, this filters the air as it enters the ventilator.
Figure 6-10. Air Inlet Filter
WARNING:
The air inlet filter is for use on a single patient and is not reusable; do not attempt to wash, clean, or reuse it.
WARNING:
Failing to replace a dirty air inlet filter, or operating the ventilator without a filter, may cause serious damage to the ventilator.
Bacteria Filter
It is highly recommended that you install a bacteria filter (see
) on the single-limb patient circuit, connected to the TO PATIENT port:
This filter protects the ventilator from contamination by the patient (primarily, rebreathed gas).
See
, item 1.
Figure 6-11. Bacteria Filter
6-14
See the manufacturer’s instructions for more information about the use and maintenance of bacteria filters.
Clinician's Manual
Humidifier
6.6
Humidifier
The humidifier (
) adds moisture (water vapor) and warms the gas in the patient circuit.
It is inserted into the patient circuit between the main outlet and the patient (see
WARNING:
During invasive ventilation (when an artificial airway bypasses the patient’s upper respiratory system), the patient’s upper respiratory system cannot humidify the incoming gas. For this reason, the use of a humidifier, to minimize drying of the patient’s airways and subsequent irritation and discomfort, is required.
WARNING:
Always position a humidification device so that it is lower than both the ventilator and the patient.
Use water traps, if necessary, to limit water in the patient circuit and periodically empty these water traps.
WARNING:
If a heated humidifier is used, you should always monitor the temperature of the gas delivered to the patient. Gas delivered from the ventilator that becomes too hot may burn the patient's airway.
WARNING:
Adding accessories to the ventilator breathing circuit, such as a humidifier and water trap(s), may result in a decrease in tidal volume delivered to the patient due to the added compressible volume of the accessory. Always assure that the patient is receiving the appropriate inspired volume when altering the breathing circuit configuration.
Figure 6-12. Humidifier
When a humidification device is used, any condensation that forms in the patient circuit is collected in the water trap. If you notice any moisture in the patient circuit, you need to replace the wet circuit components with dry ones.
See the humidification device’s instruction for information on operating, cleaning, and sterilizing the humidifier.
Clinician's Manual 6-15
Installation and Assembly
6.7
Oxygen
WARNING:
The ventilator must not be used with flammable anesthetic substances.
WARNING:
To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses.
6.7.1
Administering Oxygen
WARNING:
Oxygen therapy for patients with respiratory failure is a common and effective medical prescription. However, be aware that inappropriate oxygen use may potentially lead to serious complications, including, but not limited to, patient injury.
Oxygen administered to the patient is introduced from an external source into the machine through the oxygen connector at the rear of the ventilator. It is then integrated into the total volume of delivered gas. Remove the oxygen inlet connector from the back of the ventilator when external oxygen is not in use.
The specific oxygen flow to the patient depends on the physiological characteristics of the patient and the ventilator settings.
The oxygen flow setting should be adjusted for each patient and established in relation to a calibrated oxygen analyzer. As the factors that affect administered oxygen flow may change over time, you must ensure that these settings always correspond to the current oxygen therapy objectives specified by the physician (see section
, “ FiO2 For Various Oxygen and Ventilator Settings
”).
WARNING:
To avoid injury to the patient and/or possible damage to the ventilator: before using the ventilator, use a flow meter (flow regulator) to regulate the oxygen supply to specifications before connecting the ventilator to the oxygen supply.
WARNING:
Ensure that the oxygen supply pressure to the machine never exceeds 7 psi (50 kPa) or a flow of
15 lpm. Refer to
Table B-8. on page B-3 for sensitivity tolerances.
WARNING:
The Puritan Bennett™ 520 Ventilator can be used with an oxygen analyzer with minimum and maximum concentration alarms. Always measure the delivered oxygen with a calibrated oxygen
6-16 Clinician's Manual
Oxygen analyzer that features a minimum and maximum concentration alarm in order to ensure that the prescribed oxygen concentration is delivered to the patient.
6.7.2
Connecting the Oxygen Supply
WARNING:
Ensure that the only gas supplied to the ventilator through the dedicated oxygen supply connector is medical-grade oxygen.
WARNING:
The hose connecting the ventilator to the oxygen source must be designed exclusively for use with medical-grade oxygen. Under no circumstances should the oxygen hose be modified by the user.
In addition, the hose must be installed without the use of lubricants.
A connector (
Figure 6-13. , item 1) for an external low pressure oxygen source is available at the
rear of the ventilator. It is essential that you also use the special coupler (item 2) supplied with the ventilator to attach the external low pressure oxygen source to the connector. The connector is also fitted with a non-return airtight valve system. The non-return airtight valve system includes a stud (item 3) and a locking tab (item 4).
Figure 6-13. Rear Panel Oxygen Connector
WARNING:
Before connecting the oxygen supply, ensure that the stud on the oxygen connector ( Figure 6-13. ,
item 3) is protruding outwards.
Clinician's Manual 6-17
Installation and Assembly
WARNING:
Inspect the oxygen coupler (
Figure 6-14. , item 2) before use to ensure it has its black o-ring
attached and in good condition. Do not use an oxygen coupler with a missing, damaged, or worn o-ring.
To connect the oxygen supply system to the ventilator:
See
1.
Inspect the oxygen supply’s connector (
Figure 6-14. , item 1) to ensure that connector’s black o-ring
(item 2) is not missing.
2.
Push the oxygen supply’s oxygen connector (item 1) into the ventilator’s oxygen connector
(
, item 3).
•
• The ventilator’s oxygen connector’s locking stud (item 4) retracts.
The ventilator’s oxygen connector’s locking tab (item 5) is released, ensuring that the oxygen connection is locked and secured in place.
Figure 6-14. Connecting the Oxygen Supply System
6-18
To disconnect the oxygen supply system from the ventilator:
Note:
Ensure the oxygen source is turned off prior to placing the ventilator in standby or turning off the ventilator.
Stop the oxygen flow from the oxygen supply.
1.
2.
Press the locking tab of the ventilator’s oxygen connector, as shown in Figure 6-15. , to unlock the
oxygen connection.
Clinician's Manual
Fitting the Ventilator into the Dual Bag
Figure 6-15. Disconnecting the Oxygen Supply System
3.
Disconnect the oxygen supply’s oxygen connector by pulling it toward you.
The ventilator’s oxygen connector’s locking stud (
Figure 6-14. , item 4) will then extend out-
wards, which is required before the oxygen connector can be reconnected.
WARNING:
The coupler must not remain connected to the oxygen connector unless it also connected to a leak-proof, external oxygen gas source. When an oxygen supply is not being used with the ventilator, disconnect the oxygen source completely from the ventilator.
WARNING:
In the event of an oxygen leak, shut down the supply of oxygen at its source. In addition, remove and/or keep any incandescent source away from the device, which may be enriched with oxygen.
Circulate fresh air into the room to bring the oxygen level down to normal.
WARNING:
To prevent any interference with the internal sensors of the ventilator, do not install a humidifier upstream of the ventilator.
6.8
Fitting the Ventilator into the Dual Bag
The dual bag is a carrying bag with a dual function. It allows the Puritan Bennett 520 Ventilator to either be mounted onto a wheelchair or carried as a backpack (see
).
WARNING:
Ensure that the ventilator is switched off and disconnected from all external power supplies before installation.
To fit the ventilator into the dual bag, do the following:
1.
Open the rear panel of the dual bag.
2.
Slip the ventilator into the dual bag, pushing it completely to ensure a snug fit.
Clinician's Manual 6-19
Installation and Assembly
3.
Shut the rear panel of the dual bag, ensuring that the hook and loop fastener strips are securely fastened.
6.9
Mounting the Ventilator on a Wheelchair
WARNING:
To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses.
WARNING:
Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged.
WARNING:
Do not operate the ventilator in direct sunlight, near heat sources, outdoors, or near installations where liquid may pose a risk without first providing adequate protection for the device.
WARNING:
To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator.
WARNING:
Before using the ventilator’s internal battery, ensure that the battery is fully charged and that the charge holds. Back up ventilators or those in storage should be connected to an AC power source to protect the integrity of the battery.
WARNING:
Due to typical voltage fluctuations that occur during normal power wheelchair use, the wheelchair mains battery should never be used to power the Puritan Bennett™ 520 Ventilator, nor should the ventilator’s battery be used to power the wheelchair. The ventilator should always be connected to an independent power source (e.g. AC power, extra batteries, or DC power source).
WARNING:
Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over (see Chapter
,
“ Routine Maintenance .” This is particularly important when the ventilator is installed on a
wheelchair, because environmental conditions may cause the filter to become dirty more rapidly.
6-20 Clinician's Manual
Mounting the Ventilator on the Utility Cart
WARNING:
To minimize the risk of damage, you must use the ventilator’s Dual Bag to transport the ventilator.
See Table H-1. List of Consumables and Accessories
.
Figure 6-16. Using the Dual Bag
To install the dual bag onto a wheelchair, do the following:
1.
Unclip the two backpack straps from the side clips.
2.
Clip the suspension belt onto the central ring.
3.
Secure the dual bag on the wheelchair’s push handle.
4.
Attach the nonadjustable side of the maintaining belt to the side clip of the dual bag.
5.
Pass the maintaining belt around the back of the wheelchair.
6.
Adjust the length of the maintaining belt and attach the adjustable side of the belt to the clip on the other side of the dual bag.
6.10
Mounting the Ventilator on the Utility Cart
Match the mounting holes (item 1) on the bottom of the Puritan Bennett 520 Ventilator to the mounting studs (item 2) on the top of the utility cart platform.
Clinician's Manual 6-21
Installation and Assembly
Figure 6-17. Mounting the Ventilator on the Utility Cart
Figure 6-18. Using the Utility Cart
6-22 Clinician's Manual
Connecting the Nurse Call Cable
6.11
Connecting the Nurse Call Cable
Connect the nurse call cable (
Figure 6-19. , item 1) to the nurse call monitor connector (item 2).
Figure 6-19. Connecting the Nurse Call Cable
WARNING:
Before using the Nurse Call system, ensure that its connections are secure and it operates properly.
WARNING:
To connect the ventilator to a Nurse Call device, check the ventilator's compatibility with the Nurse
Call device and order a suitable connection cable.
WARNING:
Do not use Nurse Call devices that operate based on the closure of an electrical circuit, because the devices often do not take into account possible cable disconnection or a total loss of power. Ensure that the Nurse Call device is always connected to the ventilator.
Note:
The Puritan Bennett 520 Ventilator has been designed to accommodate connectivity with nurse call/ monitoring systems. Because it is not possible to anticipate every configuration of hardware and software associated with a nurse call/monitoring system, it is the user’s responsibility to confirm proper functionality of the system when used in conjunction with the ventilator. Verification of alarms, alerts, and patient data transmissions is required. If the system performance is not as expected, contact Technical Support for assistance troubleshooting the setup. Do not use the Puritan Bennett 520 Ventilator with a nurse call/ monitoring system until the functionality of the ventilator/system combination has been confirmed.
Note:
Complete a self-test after the cable has been installed and at regular intervals to ensure the system is operating as intended. A self-test consists of inducing an alarm and confirming the nurse call/monitoring system unit emits an audio alarm, and also confirming the audio alarm ceases once the alarm in the ventilator has been reset.
Clinician's Manual 6-23
Installation and Assembly
•
•
•
•
The nurse call function provides for remote alerts of ventilator alarm conditions (for example, when the ventilator is used in an isolation room), and features the following:
The ventilator signals an alarm using a normally open (NO) or a normally closed (NC) signal.
A remote alarm is activated when an alarm condition occurs, unless either of the following is true:
– The audio paused function is active.
– The ventilator power switch is OFF.
The alarm delay, once generated from the ventilator, to the nurse call output/input cable connectors is less than 100 ms.
The remote alarm port is an eight-pin female connector; allowable current is 100 mA at 24 VDC (max).
6-24 Clinician's Manual
7 Operating Procedures
7.1
Turning on the Ventilator
WARNING:
Before operating the ventilator, read, understand, and strictly follow the information contained in Chapter
WARNING:
The ventilator is not intended to be used for patients without breathing autonomy or who are ventilator dependent.
WARNING:
If the ventilator has been transported or stored at a temperature that differs more than
20°C (
68°F) from the temperature in which it will be operating, the ventilator should be allowed to stabilize in its operating environment for at least two (2) hours prior to use.
WARNING:
To reduce the risk of a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (such as flammable anesthetics and/or heaters) away from the ventilator and oxygen hoses.
WARNING:
While the ventilator is in use, an alternative means of ventilation should always be available in the event of a ventilator problem. Supplementary observation, appropriate for the patient's condition, is also recommended.
WARNING:
To ensure that ventilation continues uninterrupted, ensure alternative power sources are available (AC power source, extra batteries, or an auxiliary DC car adapter). Be prepared for the possibility of power failure by having an alternative means of ventilation ready for use.
WARNING:
Do not start ventilation until you ensure that the device is suitably assembled, that the air inlet filter is properly installed and is not obstructed, and that there is proper clearance all around the
7-1
7-2
Operating Procedures unit. Also ensure that the patient circuit is suitably connected to both the ventilator and the patient and that the patient circuit, including all hoses, is not damaged or obstructed.
WARNING:
Users must always possess an additional breathing circuit and exhalation valve while using the
Puritan Bennett™ 520 Ventilator.
WARNING:
Verify the functionality of the alarm conditions before connecting the patient to the ventilator.
Refer to Appendix F , “ Alarms Tests .”
WARNING:
Before starting ventilation, always verify that all settings are properly set in accordance with the required prescription.
WARNING:
If the ventilator fails the alarm tests or if you cannot complete the tests, refer to section
“ Troubleshooting ” or call your equipment supplier or Covidien.
WARNING:
Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged.
•
To turn the ventilator on:
Set the I/O switch (a covered, rocker-type switch located at the rear of the ventilator) to the I position,
Clinician's Manual
Figure 7-1. Turning on the Ventilator
Turning on the Ventilator
•
•
•
•
•
•
•
•
The following events occur:
The ventilator is turned on.
A Power On Self Test (POST) is carried out (when plugged in to an AC power source).
The front panel indicators flash (except for the indicator showing the type of power supply in use, which remains lit).
The audible alarms briefly sound.
The display’s backlight turns on.
The PURITAN BENNETT logo is shown momentarily.
The blue VENT STDBY indicator to the right of the VENTILATION ON/OFF key illuminates, indicating the device is in standby mode.
A Welcome menu screen is shown for about 5 seconds, which includes the machine hours counter
and patient hours counter, as shown in Figure 7-2.
Clinician's Manual 7-3
Operating Procedures
Figure 7-2. Welcome Menu Screen
Note:
If the ventilator had been previously stopped by use of the I/O switch while ventilation was in progress, the ventilator starts directly in ventilation mode and does not show the Welcome menu screen.
Note:
The alarm, technical fault, and event logs are stored in nonvolatile memory on the main CPU PCB, ensuring that the information is retained when the ventilator is turned off and during power loss conditions.
To skip the Welcome menu:
Press VENTILATION ON/OFF to start ventilation immediately.
The Ventilation menu screen is then shown.
Figure 7-3. Ventilation Menu Parameters
7-4
By default, the starting ventilation mode is the last one used, the settings being those that were active when the machine was last stopped.
Clinician's Manual
Setup Menu Parameters
If the ventilator’s memory of the settings is faulty, a CHECK SETTINGS alarm is activated. If this occurs, the desired parameters should be reset and saved; otherwise the machine will operate on default parameter values.
7.2
Setup Menu Parameters
7.2.1
Accessing Setup Configuration
Note:
The Locking key prevents access to the Setup menu (see section 7.8
, “
Locking the Control Panel ” on page 7-
, “ Unlocking the Control Panel ” on page 7-37 ).
Note:
The Setup menu cannot be accessed if the ventilator had been turned off, without first placing the device into standby.
Check that the ventilator’s I/O switch is set to OFF ( O ) position.
1.
2.
Press and hold the ALARM CONTROL key while switching the I/O switch to ON ( I ). Hold the key until the Setup menu appears (approximately 3 seconds). See
Figure 7-4. Setup Menu
3.
Release the ALARM CONTROL key.
7.2.2
Changing the Setup Menu Parameters
To change the Setup menu settings:
1.
Press UP or DOWN to position the cursor beside the parameter to be modified.
2.
Press ENTER .
Clinician's Manual 7-5
7-6
Operating Procedures
• The cursor changes.
• The selected parameter value flashes.
3.
Press UP or DOWN to modify the value of the selected parameter.
4.
Press ENTER to confirm the newly selected value.
Note:
When a parameter contains several setup fields (such as Date and Time) press ENTER to move from one field to the next.
Note:
If you do not confirm a change by pressing ENTER before 7 seconds elapse, the ventilator restores the setup field’s previous value.
•
The parameters in this menu include the following:
Machine Hours
•
•
•
•
•
•
•
•
•
• Language
Date
Time
Intentional Vent Stop
Pressure Unit
Alarm Tone
Patient Hours
Restore Defaults
Maintenance
Next
Machine Hours
The counter records the total ventilation time in hours (to the nearest hour) since manufacture.
Note:
The machine hour meter is reset when the CPU board is changed.
Clinician's Manual
Setup Menu Parameters
Language
The language can be set here. All messages and denominations are automatically shown in the selected language. The languages available are:
English (US)
English (UK)
German
Danish
Chinese
Turkish
Table 7-1. Languages
Finnish
Russian
Portuguese
Polish
Norwegian
Dutch
Japanese
Italian
French
Spanish
Swedish
Korean
Date
The current date can be set here. The date is shown in the format: DD MMM YYYY.
Time
The current time can be set here. The time is shown in the format: HH: MM: SS.
Intentional Vent Stop Alarm
The Intentional Ventilation Stop alarm is an alarm to warn that ventilation has been switched off by the user/caregiver and the ventilator is in standby.
To set the Intentional Vent Stop alarm:
1.
Use the UP or DOWN arrows to place the cursor at the Intentional Vent Stop alarm position.
2.
Press ENTER .
3.
Press UP or DOWN to set the message to YES.
4.
Press ENTER to confirm the selection.
Pressure Unit
The unit of pressure can be set here. It can be shown as mbar , cmH20, or hPa .
Alarm Tone
Alarm tone options include Original (louder) or Compliant (softer). The default setting is Compliant. The audible sound of Compliant is softer than the Original tone, and meets the requirements of alarm standard 60601-1-8. Original refers to the alarm tone that was shipped with the ventilator from initial product launch until the LS010101/LS010011 software update.
To change the alarm tone:
1.
Use the UP or DOWN arrows to place the cursor on Alarm Tone.
2.
Press ENTER .
3.
Use the UP or DOWN arrows to select Compliant or Original.
Clinician's Manual 7-7
7-8
Operating Procedures
4.
Press ENTER to confirm the selection.
Patient Hours
The value of this parameter is equal to the total number of hours that the patient has been ventilated.
Note:
Resetting the patient hours will also reset the trends stored in the device memory in preparation for a new patient.
To reset the Patient Hours counter to zero:
1.
Press DOWN to place the cursor at the Patient Hours line, as shown in
Figure 7-5. Resetting Patient Hours to Zero (1)
2.
Press ENTER .
• The cursor is placed on the Reset Hours line.
3.
Press ENTER .
• OFF flashes.
4.
Press UP or DOWN
to change the OFF message to YES, as shown in Figure 7-6.
Clinician's Manual
Figure 7-6. Resetting Patient Hours to Zero (2)
Setup Menu Parameters
5.
Press ENTER .
•
•
• YES is shown continuously.
A long “beep“ sounds.
The patient counter display indicates 00000h, as shown in Figure 7-7.
Figure 7-7. Resetting Patient Hours to Zero (3)
6.
Press UP or DOWN .
• The screen indicates Reset Hours: OFF, as shown in
Clinician's Manual 7-9
Operating Procedures
Figure 7-8. Resetting Patient Hours to Zero (4)
Restore Defaults
This allows the user to reset all settings back to the original manufacturer defaults except for the
Language, Date, and Time.
To restore settings back to the manufacturer defaults:
1.
Press UP or DOWN to position the cursor beside Restore Defaults, as shown in
Figure 7-9. Restoring Default Settings (1)
7-10
2.
Press ENTER . OFF flashes.
3.
Press UP or DOWN to change OFF to YES, as shown in
Clinician's Manual
Figure 7-10. Restoring Default Settings (2)
Setup Menu Parameters
4.
Press ENTER to reset all settings back to the manufacturer defaults except for Language, Date, and
Time. OFF will reappear, as shown in Figure 7-11.
Figure 7-11. Restoring Default Settings (3)
Maintenance
This option is reserved for Service personnel qualified by Covidien to ensure correct maintenance and operation of the device. For information on using the Maintenance option, refer to the
Puritan Bennett 520 Ventilator service manual.
Next
This allows the user access to Setup 2 menu. For more information, see section
7.2.3
Entering Setup 2 Menu
1.
Press UP or DOWN to position the cursor beside Next.
2.
Press ENTER .
Clinician's Manual 7-11
Operating Procedures
The Setup 2 menu is shown.
Figure 7-12. Setup 2 Menu
7-12
•
•
•
•
The parameters in this menu include the following:
Cycling Mode
Relative pressure
E Sens Setting
Back
Cycling Mode
The Cycling Mode is used to set which calculated value (I:E or I/T) appears in the parameter zoom window when changing Insp Time or Rate settings. It is also used to set the monitored data value
(I:E or I/T) shown in the monitored data window and graphics screen.
The two cycling modes represent the relationship between inspiration time to exhalation time as follows:
1.
I/T is inspiratory time (T i
) as a percentage of the total breath cycle time (T i
+ T e
).
I/T (%) = [Ti / (T i
+T e
)] x 100
2.
I:E is the ratio of inspiratory time (T i
) to exhalation time (T e
).
I:E = 1/(T e
/T i
)
In P A/C mode, the cycling ratio changes based on patient inspiration; however, the inspiratory time remains constant and corresponds to the rate and cycling ratio settings.
Absolute and Relative Pressure
The relative pressure for the inspiratory pressure setting (P Control and P Support) in PSV and P A/
C, can be set to OFF or YES and allows the choice between setting the inspiratory pressure relative to PEEP or setting an absolute inspiratory pressure. The default value is absolute (ABS).
Clinician's Manual
Setup Menu Parameters
If relative pressure is set to YES , the PEEP is added to the inspiratory pressure setting to determine the peak inspiratory pressure. If relative pressure is set to OFF , the inspiratory pressure setting will determine the peak inspiratory pressure regardless of the PEEP setting.
Relative pressure = YES: Inspiratory pressure setting + PEEP = Peak inspiratory pressure.
Relative pressure = OFF (ABS): Inspiratory pressure setting = Peak inspiratory pressure.
The symbol ABS for absolute or REL for relative will be shown at the top of the screen as follows:
Figure 7-13. Absolute and Relative Pressure
E Sens Setting
E Sens enables the operator to adjust the sensitivity of the expiratory trigger in Pressure Support breaths in PSV mode, which will cycle the breath into the expiratory phase. During a Pressure
Support inspiration, the delivered flow will reach a peak value and then begin to decelerate toward zero. The E Sens setting allows the operator to set the flow value, as a percentage of peak flow, that will cycle the breath to exhalation.The E Sens setting can be set to either POSITIVE or
NEGATIVE .
If set to POSITIVE, E Sens is based on the percentage of inspiratory peak flow. If set to NEGATIVE, E
Sens is based on the percentage of inspiratory peak flow by which the flow must decrease before exhalation is declared.
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Operating Procedures
Figure 7-14. E Sens Setting
7-14 x Seconds y1 Inspiration
Back
Allows the user to return to the Setup menu. y2 Exhalation
7.2.4
Exiting the Setup Menu
To exit the Setup menu, you must cycle the ventilator’s power.
1.
Set the ventilator’s rear panel I/O switch to OFF ( O ). Wait 30 seconds.
2.
Turn the ventilator’s I/O switch ON ( I ).
The ventilator will run through a Power On Self Test (POST) routine and then return to standby mode.
7.3
Preferences Menu Parameters
The Preferences menu is only accessible if the Locking key has not been enabled (refer to section
, “ Locking the Control Panel ” on page 7-36
, “ Unlocking the Control Panel ” on page
).
The Preferences menu is accessed from the Ventilation parameters menu, when ventilation is either on or off.
WARNING:
Setting Alarm limits to extreme values can cause the ventilator alarms to malfunction.
Clinician's Manual
Preferences Menu Parameters
Note:
Default alarm setting preferences should be entered prior to using the ventilator.
7.3.1
Preferences Menu
To show the Preferences menu:
1.
Press DOWN until the cursor is on the Preferences line, as shown in
Figure 7-15. Selecting the Preferences Menu
2.
Press ENTER . The Preferences menu is shown.
Figure 7-16. Changing Settings in the Preferences Menu
To change the settings in the Preferences menu:
1.
Press UP to place the cursor on the parameter line to be modified.
2.
Press ENTER .
• The cursor changes to the plus/minus symbol.
Clinician's Manual 7-15
Operating Procedures
• The parameter selected to be modified flashes, or for certain parameters featuring a bar graph, the indicator triangle under the bar graph becomes filled.
Figure 7-17. Modifying the Parameters
7-16
3 Indicator triangle: filled 1 Cursor: plus/minus symbol
2 Parameter value: flashing
3.
Press UP or DOWN to change the selected parameter’s value.
4.
Press ENTER to confirm the new parameter setting.
• The new parameter setting is shown.
• The cursor returns to its initial form.
Note:
If a parameter change is not confirmed by pressing ENTER before 7 seconds elapse, the ventilator resets the parameter to its previous value.
•
The parameters in this menu include the following:
Backlight
•
•
•
•
•
•
•
Contrast
Alarm Volume
Key Sound
Apnea Alarm
Disconnection Alarm
Pediatric Circuit
Ventilation Report
To adjust the various Preferences menu parameters, or to view the Ventilation Report, refer to the instructions provided in this section.
To manually exit from the Preferences menu:
Press ENTER when the cursor is on Back to Ventilation.
Clinician's Manual
Preferences Menu Parameters
•
•
You will automatically exit from the Preferences menu when the following occurs:
No keyboard action is detected before 15 seconds elapse, or
A high priority alarm is triggered.
7.3.2
Backlight
To set the backlight:
1.
Select the Backlight parameter on the screen.
2.
Set the backlight: a.
•
To set the backlight to standby, select OFF .
The effect of this setting is that if no keyboard action occurs before 1 minute elapses, the display’s backlight fades almost to off. The display will illuminate when the following occurs:
Any one of the keys on the keyboard is pressed
• An alarm is triggered b.
To set the backlight to light continuously, select YES . This setting ensures that the display is continuously lit.
Note:
If running the ventilator on its internal battery or on an external battery, Covidien recommends keeping the backlight setting to OFF to reduce power consumption.
3.
Press ENTER to confirm the new Backlight setting.
The default setting for Backlight is YES (backlight lit continuously).
7.3.3
Contrast
To set the Contrast:
1.
Select the Contrast parameter on the screen.
2.
Set the Contrast level: a.
To increase the contrast, press UP . This change can be observed as the cursor moves to the right:
Figure 7-18. Increasing the Contrast
• The display contrast progressively increases.
Clinician's Manual 7-17
Operating Procedures b.
To decrease the contrast, press DOWN . This change can be observed as the cursor moves to the left:
Figure 7-19. Decreasing the Contrast
3.
• The display contrast progressively decreases.
Press ENTER to confirm the new Contrast setting.
When ventilation is stopped, the contrast can also be changed directly from the currently shown menu by pressing ALARM CONTROL continuously, while repeatedly pressing UP or DOWN .
The default setting for Contrast is the medium setting (the middle of the bar graph).
7.3.4
Alarm Volume
WARNING:
The sound level of the alarms should be adjusted according to the installation environment and the size of the area monitored by the patient’s caregiver. Ensure that the alarm sound apertures at
the front of the device are never obstructed. See section 7.3.4
, “ Alarm Volume ” on page 7-18 .
To set the Alarm Volume:
1.
Select the Alarm Volume parameter on the screen. See section 7.3.1
” on page
.
2.
Set the Alarm Volume level: a.
To increase the sound level of alarms, press UP . This change can be observed as the cursor moves to the right:
Figure 7-20. Increasing the Alarm Volume b.
• The buzzer activates and increases in sound level as the setting increases.
To decrease the sound level of alarms, press DOWN . This change can be observed as the cursor moves to the left:
Figure 7-21. Decreasing the Alarm Volume
3.
• The buzzer activates and decreases in sound level as the setting decreases.
Press ENTER to confirm the new Alarm Volume setting.
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Preferences Menu Parameters
Current hospital standards require a minimum sound level of 55 dB (A) at a distance of 3 meters
(9.84 feet), which corresponds to the lowest possible volume setting. The alarm sound level range is described in section
. If a high priority alarm is not paused within 60 seconds of activation, the sound level automatically raises to the maximum level, regardless of the original setting.
The default setting for Alarm Volume corresponds to a level halfway between the minimum and maximum values.
7.3.5
Key Sound
This setting is used to select the sound emitted when pressing keys on the ventilator’s keyboard.
To set Key Sound:
1.
Select the Key Sound parameter on the screen.
2.
Select one of the following four options:
•
• OFF—No sound is emitted when a key is pressed.
Key tone—A “clock” sound is emitted when a key is pressed.
• Accept tone—A “beep” sounds when ENTER is pressed to confirm a setting.
• All tones on—A “clock” sound is emitted when all keys are pressed and a beep sounds when
ENTER is pressed to confirm a setting.
3.
Press ENTER to confirm the new Key Sound setting.
The default setting for Key Sound is Accept tone.
Note:
Whatever the selected Key Sound setting, pressing the VENTILATION ON/OFF key triggers a “beep” at ventilation start and a double “beep“ at ventilation stop.
7.3.6
Apnea Alarm
To set the Apnea alarm:
1.
Use the UP or DOWN arrow keys to place the cursor at the Apnea Alarm position.
2.
Press ENTER .
3.
Press UP or DOWN to set the message to YES. Setting the key to OFF means the Apnea alarm will not sound when the ventilator is stopped.
4.
Press ENTER to confirm the selection.
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Operating Procedures
WARNING:
The Apnea Alarm should be set to YES if an audible alarm is desired when apnea events occur.
Figure 7-22. Setting the Apnea Alarm
7-20
Note:
This activates/deactivates the Apnea alarm but not the Apnea Time setting. The Apnea Time setting can be set in the Ventilation menu.
7.3.7
Disconnection Alarm
To set Disconnection alarm:
1.
Use the UP or DOWN arrow keys to place the cursor at the Disconnection alarm position.
2.
Press ENTER .
3.
Press UP or DOWN arrows to adjust the setting between 5 and 62 seconds.
4.
Press ENTER to confirm the selection.
Note:
Values set in the ventilation mode may supersede disconnection alarm values. Refer to Chapter 5
, “
.”
7.3.8
Pediatric Circuit
To choose a pediatric circuit:
1.
Use the UP or DOWN arrows to place the cursor at the Pediatric circuit position.
2.
Press ENTER .
Clinician's Manual
Setting the Ventilation Mode
3.
Press UP or DOWN to set the message to YES. Setting the ventilator to OFF configures the device for an adult circuit.
4.
Press ENTER to confirm the selection.
Note:
The default setting is OFF (the ventilator is set for adult use).
7.3.9
Ventilation Report
To access the Ventilation Report:
1.
Use the UP or DOWN arrows to place the cursor at the Ventilation Report position.
2.
Press ENTER .
Figure 7-23. Accessing the Ventilation Report
Note:
The report is shown for 5 minutes then screen reverts to the Preferences menu.
To exit the Ventilation Report:
Press ENTER .
7.4
Setting the Ventilation Mode
The ventilation mode can be changed from the Ventilation parameters menu or the Alarm parameters menu, as long as the Locking key is not enabled (refer to section
,” on page
, “ Unlocking the Control Panel ” on page 7-37
).
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Operating Procedures
The procedure to change the ventilation mode depends on the ventilation status, as described in section
and section
.
WARNING:
The inspiration trigger threshold should be carefully modified in order to avoid the risk of false triggering or “autotriggering” of the ventilator. For example, Level 0P, the most sensitive mode, is recommended for pediatric use. However, for an adult, this setting may result in autotriggering.
WARNING:
This ventilator offers a choice of breath delivery modes and types. Throughout the patient’s treatment, the clinician should carefully select the ventilation modes and/or breath type to use for that patient. This selection should be based on the clinician’s clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time, and considering the benefits, limitations and operating characteristics of each mode and/or breath type.
7.4.1
Changing Modes While Ventilation is on Standby
To change ventilation modes while on standby:
1.
Place the cursor on the first line of the menu (general information line) using the UP key.
Figure 7-24. Changing Ventilation Modes While on Standby
7-22
2.
Press ENTER .
• The cursor changes to: .
• The mode name flashes.
3.
Press UP or DOWN until the required mode is shown.
4.
Press ENTER to confirm the mode selected.
• The cursor returns to normal.
Clinician's Manual
Setting the Ventilation Mode
• The new mode is shown with its ventilation parameters.
Note:
If the ventilation mode change is not confirmed by pressing ENTER before 7 seconds elapse, the ventilator restores the previous mode.
7.4.2
Changing Modes During Ventilation
WARNING:
When changing the mode during ventilation, significant transitions of pressure, flow or cycling rate might occur, depending on the difference between the modes. Before setting the new mode, first ensure that the settings between the different modes are compatible. This reduces the risk of discomfort and harm to the patient.
Changing ventilation modes during ventilation:
1.
Place the cursor on the first line of the menu (general information line) using the UP key (
Figure 7-25. Changing Ventilation Modes During Ventilation
2.
Press ENTER .
• The cursor changes to: .
• The mode name flashes.
3.
Press UP or DOWN until the required mode is shown.
4.
Press ENTER to confirm the mode selected.
•
• The name of the new mode selected is shown at the top left followed by the flashing INACTIVE
status indicator ( Figure 7-26. , item 1).
The settings for the new mode are shown on the left (
Figure 7-26. , item 2) and the monitored
values for the mode in progress on the right (
Clinician's Manual 7-23
Operating Procedures
•
•
The confirmation line “Accept Mode:YES“ is shown on the bottom left
(
, item 3).
The name of the mode in progress is shown at the top right followed by the continuous “ACTIVE“
status indicator ( Figure 7-26. , item 4).
Figure 7-26. Showing Active and Inactive Modes
The Alarm menu screen in
Figure 7-27. indicates the active and inactive mode information being
shown, along with the Accept Mode:Yes line, alarm parameter settings, and patient values.
Figure 7-27. Changing the Settings of the New Mode
7-24
5.
Change the settings of the new mode, including alarms, if necessary.
6.
Press DOWN to place the cursor on the Accept Mode:YES line.
7.
Press ENTER to confirm the mode change.
•
The new mode selected is shown with its settings. It is applied at the beginning of the next exhalation phase if it occurs during inspiration or immediately if it occurs during exhalation.
It is not mandatory to change modes during ventilation (see steps 6 and 7, above). The settings of the next (INACTIVE) mode can be “prepared” while ventilation is in progress in the current
Clinician's Manual
Setting Ventilation Parameters
(ACTIVE) mode. The modifications will be saved for this next mode, whether or not it is used immediately afterwards.
When setting the parameters of the future and currently inactive modes, the monitoring data for the mode in progress are shown in the window to the right of the menu and also in the central
(“current”) column of the table on the Alarm menu screen.
When changing the value of a parameter in this inactive mode, the monitoring data shown in the window on the right side of the screen are temporarily hidden by the display of the value currently being changed. This is shown in
, as the PEEP setting is adjusted in the inactive mode.
Figure 7-28. Changing Ventilation Modes and Parameters
If an alarm is triggered during the setting of an inactive mode, its message is shown in the alarm message area.
When the menu of an inactive mode is shown and no changes are made by the user on the keyboard within 14 seconds, the active ventilation mode in use reappears on the screen and the
Accept Mode:YES line disappears.
The menu of the active mode can also be recalled without waiting for this delay by directly restoring the name of the mode on the general information line.
The ventilation parameters of the inactive mode and the current mode remain in memory until some or all of the parameters are modified again; this is true even after the machine is stopped.
7.5
Setting Ventilation Parameters
Ventilation parameters can be changed as long as the Locking key is not activated (refer to section
, “ Unlocking the Control Panel ” on page 7-37 ).
WARNING:
In adult or pediatric use ensure that the adjusted tidal volume is compatible with the needs of the patient.
Clinician's Manual 7-25
Operating Procedures
Ventilation is not interrupted by the adjustment of a value. It continues according to previous settings. The new settings are applied ONLY after they are confirmed and synchronized in the next breath cycle, except for the I Sens setting, which is applied immediately.
To modify a ventilation parameter:
1.
Place the cursor on the line of the parameter to be modified using the UP or DOWN key.
2.
Validate your intention to modify the parameters using the ENTER button. See
•
•
• The cursor changes (
The parameter value flashes (
, item 2).
A zoom of the parameter value is shown in the right-side of the window
(
, item 3).
Figure 7-29. Modifying a Ventilation Parameter
7-26
3.
Press UP or DOWN to select the value desired for the parameter (continuing to press on these keys speeds up the progression of values shown).
4.
Press ENTER to confirm the selected value.
•
• The new parameter value is shown continuously.
The zoom disappears.
• The cursor returns to normal.
Note:
If a parameter change is not confirmed by pressing ENTER before 7 seconds elapse, the ventilator restores the parameter’s previous value.
Clinician's Manual
Setting Ventilation Parameters
7.5.1
Links between Ventilation Parameters
The adjustment ranges of certain parameters are limited in order to remain compatible with the levels of other previously set parameters. For additional information on the interdependence between ventilation parameters, refer to Chapter
The message “Setting limited by...“ is shown and identifies the parameter (or parameters) that is blocking the setting.
, item 1, shows that P Support cannot be set above 35 when PEEP is set to 20 and relative pressure is set to YES ; this value is limited by PEEP because their sum cannot exceed 55 mbar.
Figure 7-30. Setting Links Between Ventilation Parameters
•
•
Two possibilities exist in this case:
Allow the PEEP setting to remain at 20, but the P Support cannot be increased.
Reduce PEEP so that the P Support setting can be set higher than 35 to ensure that their sum is no greater than 55.
7.5.2
Links between Ventilation and Alarm Parameters
Setting a ventilation parameter takes priority over an alarm threshold setting and leads to automatic readjustment of the alarm setting threshold so that the interdependence between the two remains unchanged.
Once the ventilator is in service at the patient’s home, you should use the Locking key to block access to changing any settings (see section
, “ Locking the Control Panel ” on page 7-36 ).
WARNING:
Before dispensing the ventilator to caregivers or the patient for home use, ensure the Locking key is activated so that critical ventilator settings are not modified.
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Operating Procedures
7.6
Setting Alarm Parameters
Alarm parameters can be changed from the Alarm menu, if the Locking key is not enabled (refer
, “ Locking the Control Panel ” on page 7-36 and section
).
Note:
Adjustable alarms should not be systematically canceled; instead, they should be adjusted according to the needs and condition of the patient.
Note:
Default alarm setting preferences should be entered prior to using the ventilator.
To modify an alarm parameter:
1.
Ensure that the Alarm menu is shown, with a list of alarm parameters and columns for the minimum, current, and maximum alarm parameter values (
2.
Put the cursor next to the alarm parameter to be modified using the UP or DOWN key.
3.
Confirm your intention to modify the parameters using the ENTER key.
•
•
• The cursor changes. (
The parameter in the Min column flashes (
A zoom of the Min parameter is shown on the right side of the screen (
, item 3).
Figure 7-31. Modifying Alarm Parameters—Min Value
7-28
4.
Press UP or DOWN to modify the value of the parameter.
5.
Press ENTER to confirm the value selected.
•
The new value for the Min column is continuously shown ( Figure 7-32. , item 1).
Clinician's Manual
Setting Alarm Parameters
•
• The value of the Max column flashes (
, item 2).
A zoom of the Max parameter value is shown on the right side of the window (
Figure 7-32. Modifying Alarm Parameters—Max Value
6.
Press UP or DOWN to modify the value of the parameter.
7.
Press ENTER to confirm the value selected.
•
•
• The new value is continuously shown.
The zoom disappears.
The cursor returns to normal.
An alarm is set to OFF (the alarm will not be triggered) when its maximum setting limit (for the
Max value) or its minimum setting limit (for the Min value) is reached by successively or continuously pressing UP or DOWN , respectively.
Note:
If a parameter change is not confirmed by pressing ENTER before 7 seconds elapse, the ventilator restores the parameter’s previous value.
Blocking of an Alarm Threshold Linked to a Ventilation Parameter
Setting a ventilation parameter takes priority over an alarm threshold setting. Therefore, if a ventilation parameter is modified when linked to an alarm threshold, the alarm setting threshold is automatically adjusted so that the interdependences linking them are always maintained.
However, if the alarm setting threshold is modified, it cannot be changed beyond the limit of the interdependence with the ventilation parameter to which it is linked. When the alarm setting limit is reached, the message “Setting limited by...“ indicates the name of the linked ventilation parameter(s) that are limiting the parameter’s setting value.
•
Four possibilities exist in this case:
The alarm parameter remains set to OFF.
Clinician's Manual 7-29
Operating Procedures
•
•
The alarm parameter setting is changed in relation to the value required at the start and the limits on the ventilation parameter (or parameters) remain unchanged.
The setting of the ventilation parameter (or parameters) is changed to enable the alarm threshold to be set to the required value.
• The alarm parameter is not set to OFF but the ventilation parameter change has no impact on the alarm setting.
WARNING:
The level of inspiratory resistance of the circuit and accessories (bacteria filter, humidifier) must be as low as possible. Settings—particularly the PATIENT DISCONNECTION alarm, maximum inspired volume (Max VTI), and minimum inspired volume (Min VTI) settings—must be periodically adjusted according to changes in the patient circuit resistance—especially when filters are replaced.
WARNING:
Adjustable alarms should not be systematically canceled; instead, they should be adjusted according to the needs and condition of the patient.
7.7
USB Menu Parameters
The USB menu is accessible even if the Locking key has been enabled (refer to section
, “
Locking the Control Panel ” on page 7-36
, “ Unlocking the Control Panel ” on page 7-37
).
The USB menu is automatically shown when the USB memory device is connected to the ventilator, when ventilation is either on or off.
Only one USB memory device shall be connected at any time, otherwise an error message will be shown. The USB menu is not accessible from the Setup menu or Maintenance menu.
To access patient data via a PC, a dedicated software package, Puritan Bennett Respiratory Insight
Software, is available for clinicians. Contact Covidien or your Puritan Bennett product representative for further information.
7-30 Clinician's Manual
USB Menu Parameters
7.7.1
USB Memory Device Specifications
Characteristics
USB compatibility
Number of files
USB size
Supported Formats
USB flash memory USB 2.0 or USB 1.1, 32 bit format
Maximum 999 (sector size: 512-2048 bytes)
128 MB to 4GB (to guarantee accuracy of transfer time, at least
10% of the USB memory device capacity must be free).
7.7.2
USB Menu
To access the USB menu when a USB memory device is connected:
Press the MENU key several times, until the USB menu appears:
Figure 7-33. Selecting the USB Menu
•
•
In case of high priority alarm activation, the ventilator will automatically show the alarm page. To return to the USB menu, press the MENU key.
•
The adjustable parameters in this menu include the following:
Transfer Continuously
Transfer Trends
Erase Key
7.7.3
Transfer Continuously
Up to 48 hours worth of data can be transferred from a ventilator to a USB memory device.
To record continuously, the USB memory device must be permanently connected to the ventilator with ventilation active.
Clinician's Manual 7-31
Operating Procedures
•
The following data will be recorded to the USB memory device:
Monitoring: pressure, leak waveforms, and inspired flow
• Trends: leaks, VTI, Rate, I:E, M. Vol, PIP, and PEEP measurements.
The data can be accessed by a doctor or service provider using the Puritan Bennett Respiratory
Insight Software.
Figure 7-34. Selecting Transfer Continuously
7-32
To transfer continuous data from a ventilator to a USB memory device:
1.
Use the UP or DOWN arrow keys to place the cursor at the Transfer Continuously position.
2.
Press ENTER .
•
• The cursor changes to the plus/minus symbol.
The parameter selected to be modified flashes.
3.
Press UP or DOWN to change the selected parameter’s value.
4.
Press ENTER to confirm the new parameter setting.
•
• The new parameter setting is shown continuously.
The cursor is placed at the STOP position.
5.
To manually stop continuous transfer, press the ENTER key.
If a parameter change is not confirmed by pressing ENTER before 7 seconds elapse, the ventilator resets the parameter to its previous value.
Note:
All ventilator menus remain accessible during transfer time.
Clinician's Manual
USB Menu Parameters
Note:
The message “TRANSFER IN PROGRESS... REMAINING TIME” is shown during the transfer time.
Note:
Other functions of the USB memory device are not available during continuous recording.
Note:
If the memory capacity on the USB memory device is insufficient, the message “TRANSFER NOT ALLOWED
- USB CAPACITY INSUFFICIENT” is shown and data transfer is not allowed. Delete the data on the USB
memory device before restarting data transfer. Refer to deletion process (section 7.7.5
, “
”).
Note:
In case of USB memory device disconnection or transfer error, the message “TRANSFER ERROR - USB
DISCONNECTION” or “TRANSFER ERROR - TECHNICAL PROBLEM” is shown. In this case, restart the transfer process. If the problem persists, contact your technical service representative.
7.7.4
Transfer Trends
Up to 1 year’s worth of trend data can be transferred from a ventilator to a USB memory device.
Ventilation trends, such as leaks, VTI, Rate, I:E, M. Vol, PIP, and PEEP measurements, can be transferred from the ventilator to a USB memory device.
The data can be accessed by a doctor or service provider using the Puritan Bennett Respiratory
Insight Software.
Figure 7-35. Selecting Transfer Trends
To transfer trend data from a ventilator to a USB memory device:
1.
Use the UP or DOWN arrow keys to place the cursor at the Transfer Trends position.
2.
Press ENTER .
Clinician's Manual 7-33
Operating Procedures
•
•
•
• The cursor changes to the plus/minus symbol.
The parameter selected to be modified flashes.
3.
Press UP or DOWN to change the selected parameter’s value.
4.
Press ENTER to confirm the new parameter setting.
The new parameter setting is shown continuously.
The cursor is placed at the STOP position.
5.
To manually stop trend transfer, press ENTER .
Note:
If a parameter change is not confirmed by pressing ENTER before 7 seconds elapse, the ventilator resets the parameter to its previous value.
Table 7-2. Trends Data Transfer Time from Ventilator to USB Memory Device
Amount of trends data
(in months)
3 months
Transfer time from ventilator to
USB memory device
Approximately 2 minutes
6 months
9 months
Approximately 4 minutes
Approximately 6 minutes
12 months Approximately 8 minutes
Note:
The message “TRANSFER IN PROGRESS... REMAINING TIME” is shown during the transfer time.
Note:
Other USB memory device functions are available during transfer of trends.
Note:
If the memory capacity on the USB memory device is insufficient, the message “TRANSFER NOT ALLOWED
- USB CAPACITY INSUFFICIENT” is shown and data transfer is not allowed. Delete the data on the USB memory device before restarting data transfer. Refer to deletion process (section
, “
Note:
In case of USB memory device disconnection or transfer error, the message “TRANSFER ERROR - USB
DISCONNECTION” or “TRANSFER ERROR - TECHNICAL PROBLEM” is shown. In this case, restart the transfer process. If the problem persists, contact your technical service representative.
7-34 Clinician's Manual
7.7.5
Erase Data from the USB Memory Device
To erase data from the USB memory device:
1.
Use the UP or DOWN arrow keys to place the cursor at the Erase key position.
2.
Press ENTER .
•
• The cursor changes to the plus/minus symbol.
The parameter selected to be modified flashes.
3.
Press UP or DOWN to change the selected parameter’s value.
4.
Press ENTER to confirm the new parameter setting.
•
• The new parameter setting is shown continuously.
The cursor is placed at the STOP position.
Figure 7-36. Erasing Data from the USB Memory Device
USB Menu Parameters
WARNING:
Deletion erases ALL files present on the USB memory device.
Note:
The message “ERASE IN PROGRESS... REMAINING TIME” is shown during the deletion time.
Note:
The deletion time of a full USB memory device is less than 1 minute.
Note:
Other USB memory device functions are not available during deletion.
Note:
Once deletion of the USB memory device has been started, it cannot be paused, stopped, or canceled.
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Operating Procedures
Note:
All ventilator menus remain accessible during deletion.
Note:
In case of USB memory device disconnection or deletion error, the message “TRANSFER ERROR - USB
DISCONNECTION” or “ERASE ERROR - TECHNICAL PROBLEM” is shown. In this case, restart the erase process.
If the problem persists, contact your technical service representative.
7.8
Locking the Control Panel
When the machine is in service at a patient’s home, it is strongly recommended that you prevent accidental or unauthorized ventilator adjustments from occurring by enabling the Locking key.
The Locking key is a software function that prohibits access to the ventilation and alarm parameter settings and changes to the ventilation mode.
WARNING:
Before dispensing the ventilator to caregivers or the patient for home use, ensure the Locking key is activated so that critical ventilator settings are not modified.
To enable the Locking key:
•
Simultaneously press the UP and the DOWN keys for at least 6 seconds.
The Locking key symbol ( Figure 7-37. , item 1) appears in the top left corner of the screen.
Lines which are no longer accessible are preceded by a dash “–“ ( Figure 7-37. , item 2).
•
Lines which remain operational keep their initial line access symbol.
•
Figure 7-37. Enabling the Locking Key
7-36 Clinician's Manual
Unlocking the Control Panel
7.9
Unlocking the Control Panel
•
To disable the Locking key:
•
Simultaneously press the UP and the DOWN keys for at least 6 seconds.
The Locking key symbol disappears.
The initial line access symbol is shown in front of each line.
7.10
Starting Ventilation
Before starting ventilation, refer to Appendix
E , “ Operational Verification Checklist
” and set the parameter values in the Preferences menu (refer to section
, “
” on
).
WARNING:
Verify the functionality of the alarm conditions before connecting the patient to the ventilator.
WARNING:
Before starting ventilation, ensure that the device is properly assembled and that the air inlet, cooling vents, and alarm sound diffusion holes are not obstructed. Ensure also that the patient circuit is of the proper configuration, properly connected to the ventilator, and that the circuit hoses are neither damaged nor compressed and contain no obstructions or foreign bodies.
When the ventilator is in standby (the ventilator is on, but ventilation has not started), a message that prompts the ventilator operator to press VENTILATION ON/OFF to start ventilation is shown
in the right-hand window of the ventilation and alarm menus ( Figure 7-38.
).
Figure 7-38. Prompt to Start Ventilation
Clinician's Manual 7-37
Operating Procedures
•
•
•
To start ventilation:
•
Press and release VENTILATION ON/OFF
, item 1).
The blue light indicator, at the upper right of the VENTILATION ON/OFF key (
, item 2), turns off.
A “beep“ sounds.
The ventilation starts.
The values of the monitored parameters are shown in the right-hand window.
Figure 7-39. Starting Ventilation
7-38
7.11
Stopping Ventilation
WARNING:
Do not allow a patient to remain connected to the ventilator when ventilation is stopped, because a substantial quantity of expiratory gas, primarily carbon dioxide, may be inhaled by the patient.
In some circumstances, inhaling carbon dioxide may lead to under-ventilation, suffocation, and serious injury or death.
You can stop your ventilator at any time.
To stop the ventilator:
1.
Press and hold the VENTILATION ON/OFF key (
Figure 7-39. , item 1) for 3 seconds.
• A message prompting the user to keep the button pressed appears on the monitoring window, as shown in the graphic below:
Clinician's Manual
Figure 7-40. Stopping Ventilation (1)
Stopping Ventilation
2.
While keeping the VENTILATION ON/OFF key pressed:
• A new message appears that directs the user to press the key again to confirm ventilation stop (as shown in
).
Figure 7-41. Stopping Ventilation (2)
• A double “beep“ sounds.
3.
Release the VENTILATION ON/OFF key.
•
•
•
• Press the VENTILATION ON/OFF key within 5 seconds to confirm stop, otherwise ventilation will continue.
Ventilation stops.
The blue LED located to the upper-right of the VENTILATION ON/OFF key (
, item 2) illuminates to indicate ventilation is on standby.
A prompt for a new start of ventilation is shown (see Figure 7-38. on page 7-37 ).
Clinician's Manual 7-39
Operating Procedures
7.12
Turning Off the Ventilator
WARNING:
When the ventilator is switched back on after it was switched off while ventilation was in progress, it will immediately begin ventilating—without the user first having to press the VENTILATION ON/
OFF key.
WARNING:
Handle the ventilator with care after use, particularly when ambient temperatures are high. Some ventilator surfaces may be very hot, even if safety specifications are not exceeded.
•
Set the I/O switch to the O position to turn off the ventilator.
The blue LED to the right of the VENTILATION ON/OFF key turns off.
• The ventilator screen switches off.
Note:
When the ventilator is completely stopped, but is still connected to the AC power source (the green AC
POWER indicator is illuminated), the internal battery continues charging.
Note:
A continuous alarm condition will be activated if the ventilator power switch is turned off while ventilation is in progress. When the power switch is turned back on again, the ventilation will resume without having to press the VENTILATION ON/OFF button.
7-40 Clinician's Manual
8 Internal Battery
WARNING:
Even though the Puritan Bennett™ 520 Ventilator meets current safety standards, and although the internal Lithium-ion battery of the device is considered to be Dangerous Goods for transport in commerce, this devices lithium battery is below the 100Wh threshold and is therefore excepted from being a Class 9 – Miscellaneous - Dangerous Goods (DG). As such, the Puritan
Bennett™ 520 Ventilator and/or the associated Lithium-ion battery are subject to some transport conditions under the Dangerous Goods Regulation for air transport (IATA: International Air
Transport Association), International Maritime Dangerous Goods code for sea and the European
Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) for
Europe. Private individuals who transport the device are excluded from these regulations although for air transport some requirements apply. For air transport; the Puritan Bennett™ 520
Ventilator is permitted as checked-in or carry-on baggage. Spare batteries may be taken on board as carry-on luggage only. This classification and regulatory requirements may vary depending upon the country and mode of transport. Therefore it is recommended that users verify with the carrier / airline as to which measures to take before the voyage.
WARNING:
Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12–30 VDC power source (via the DC power cable) does not enable charging of its internal battery.
WARNING:
The maximum recommended shelf life of the internal battery is two (2) years. Do not use a battery that has been stored for two years or more prior to its first use.
WARNING:
Periodic recharging is important to help maximize useful life of the battery. Do not store the internal battery for extended periods, without recharging, as this may reduce the maximum life.
8.1
Battery Capacity
The reserve capacity offered by the internal battery depends on the level of ventilation parameters, the environmental conditions (primarily in terms of temperature) and the physiological characteristics of the patient.
8-1
8-2
Internal Battery
With a fully charged battery at a normal room temperature of 25ºC (±5ºC), the ventilator can be expected to operate on internal battery power for the average durations shown in
Checking the battery charge level requires that the ventilator be running on battery power at the time of the battery check. To check the battery charge level, temporarily disconnect the ventilator from AC power (while in standby mode or while providing ventilation) and read the percent charge level shown adjacent to the battery icon at the top of the ventilator's display screen.
Table 8-1. Internal Battery Reserve Capacity
Displayed values Average operating time on internal battery power
1
Vt = 200 ml (±5 ml)
PIP = 10 mbar (±2 mbar)
Rate = 20 bpm
Vt = 300ml (±5 ml)
PIP = 20 mbar (±2 mbar)
Rate = 15 bpm
5 hours (–10%)
4 hours (–10%)
Vt = 500 ml (±5 ml)
PIP = 30 mbar (±2 mbar)
Rate = 15 bpm
Vt = 750 ml (±5 ml)
PIP = 45 mbar (±2 mbar)
Rate = 20 bpm
(maximum ventilation parameters)
3 hours (–10%)
2 hours (–10%)
1 Average durations shown are with a fully charged battery having less than 50 charge/recharge cycles.
8.2
Battery Operation
WARNING:
Before using the ventilator’s internal battery, ensure that the battery is fully charged and that the charge holds. Back up ventilators or those in storage should be connected to an AC power source to protect the integrity of the battery.
Note:
Buzzer and battery alarms may occur when the unit is first powered on after the internal battery has been completely drained. Connect to an AC power source and recycle power.
•
In the event of AC power interruption or disconnection of the external AC or DC power supply, the ventilator automatically switches to its internal battery and the following events occur:
The battery symbol is shown at the top on the general information line.
Battery reserve capacity is shown on the right of the battery symbol.
•
Clinician's Manual
Battery Operation
• The internal battery indicator at the top left of the ventilator’s front panel is continuously lit
(
Figure 8-1. Internal Battery Indicator
• A loss of external supply alarm is activated.
If ventilation is stopped, the internal battery reserve capacity is shown as a percentage of battery charge. See
Figure 8-2. Battery Reserve Capacity as a Percentage
If the ventilator is running, the internal battery reserve is momentarily shown as a percentage.
Then, after the ventilator calculates the battery time remaining (which takes about 2 minutes, depending on the power consumption of the ventilator), the internal battery reserve is then
shown in hours and minutes (rounded to the nearest 10 minutes). See Figure 8-3.
Clinician's Manual 8-3
Internal Battery
Figure 8-3. Battery Reserve Capacity in Hours and Minutes
8-4
The LOW BATTERY and EMPTY BATTERY alarms (see Chapter
5 , “ Alarms and Troubleshooting ”) are
triggered when the internal battery reserve is reduced.
WARNING:
Due to its limited internal battery’s reserve capacity, the ventilator should only be operated on the internal battery when no other power source is available. Ensure that the internal battery never becomes fully discharged.
WARNING:
When the LOW BATTERY alarm is triggered, immediately connect the ventilator to an AC power supply to maintain ventilation and recharge the internal battery.
From the time that an EMPTY BATTERY alarm is activated, if no external supply is connected to the ventilator, other alarms may be triggered due to insufficient supply voltage.
In the final discharge phase, the EMPTY BATTERY alarm will become continuous, and ventilation may be interrupted at any time during this phase.
Note:
The EMPTY BATTERY alarm symbol may disappear shortly before the ventilator completely stops, but it always triggers a final, continuous alarm.
8.3
Testing the Battery
Your ventilator continuously and automatically checks the state of the internal battery, even when the battery is not used as the main source of energy. The BATTERY FAULT1 alarm is activated whenever a problem is detected in the battery or the charger.
However, on a monthly basis you should disconnect the ventilator from the external power supply to check the integrity of the connections linking the internal battery to other ventilator components.
Clinician's Manual
Recharging the Battery
8.4
Recharging the Battery
In the event that the battery charge level is considered insufficient, as per the reserve capacity display, recharge of the internal battery is necessary. In general, it is recommended that the ventilator be allowed to charge when the battery drops below 80%, and that the ventilator be recharged systematically after storage and before using it again.
Note:
To avoid cycling and extend battery life while connected to an AC power source, the battery will not begin charging until it has dropped below an 85%-90% charge.
To charge the internal battery, do the following:
•
Connect the ventilator to the AC power source.
The AC POWER indicator illuminates ( Figure 8-4. , item 1).
The INTERNAL BATTERY indicator flashes (
, item 2). •
Figure 8-4. Power Indicators When Charging the Battery
When the battery charge is complete, the INTERNAL BATTERY indicator turns off.
Clinician's Manual 8-5
8-6
Internal Battery
WARNING:
Even if the INTERNAL BATTERY indicator is off, charge of the battery may sometimes be incomplete regardless of charge time when the ambient temperature is above 40°C (104°F). This is due to the characteristics of the battery’s internal heat safety device.
Although it is not necessary to start the ventilator to charge the battery, charging the battery during operation will increase the time required to fully charge the internal battery.
When recharging a depleted internal battery, it may be necessary to leave the ventilator on charge for up to 6 hours if the ventilator is on standby and about 13 hours if ventilation is operating.
WARNING:
Ensure that the ventilator’s internal battery is fully charged before connecting the ventilator to an external DC power source. Powering the ventilator using an external 12–30 VDC power source (via the DC power cable) does not enable charging of its internal battery.
8.5
Storage
•
If the ventilator is to be stored for an extended period of time, it is not necessary to remove the battery. However, the ventilator should be stored in cool, dry, well-ventilated environment, as follows:
Temperature: approximately 21°C (70°F)
• Humidity: less than 80% RH
Note:
When the device is in storage it should be recharged monthly to maximize battery life.
If the battery is stored for more than 1 month at a temperature greater than 21°C (70°F), or for more than 1 or 2 weeks at a temperature greater than 45°C (113°F), the reserve capacity of the battery may be affected. It will then be necessary to recharge the battery before using it again.
If the ventilator has been in storage for longer than 30 days, connect it to an AC power source, turn on the unit by the I/O switch at the rear of the ventilator, and let it charge for 15 minutes prior to starting ventilation.
The battery should not be stored for more than 2 years, whatever the conditions.
Note:
Fully charge the internal battery prior to disconnecting from AC power source (“mains”).
Clinician's Manual
9 Cleaning
WARNING:
A patient treated by mechanical ventilation is highly vulnerable to the risks of infection. Dirty or contaminated equipment is a potential source of infection. Clean the ventilator and its accessories regularly and systematically before and after each use and following any maintenance procedure to reduce the risks of infection.
WARNING:
To reduce the risk of infection, wash your hands thoroughly before and after handling the ventilator or its accessories.
9.1
Cleaning the Ventilator
Clean all external panels and surfaces before and after each patient use and as often as necessary to keep the ventilator clean. You should clean the ventilator periodically, whenever it is soiled or dirty, before any maintenance operation, and before storing the ventilator.
WARNING:
Use all cleaning solutions and products with caution. Read and follow the instructions associated with the cleaning solutions you use to clean your ventilator. Use only those solutions listed in
WARNING:
The ventilator should never be immersed in any liquid, and any liquid on the surface of the device should be wiped away immediately.
WARNING:
To avoid damage to the ventilator, in particular the batteries or electrical components, fluids must not be allowed to enter the device, particularly through the air inlet filter or the cooling apertures located in the side, rear, and bottom panels of the ventilator.
To clean the surface of the ventilator:
1.
Dip a clean, soft cloth into a mixture of mild soap and water, or other approved cleaning solution.
for a list of approved cleaning solutions.
9-1
9-2
Cleaning
2.
Table 9-1. Approved Cleaning Solutions for Exterior Ventilator Surfaces
Description
Mild dishwashing detergent
70% isopropyl alcohol (rubbing alcohol)
10% chlorine bleach (90% tap water)
Glutaraldehyde
Hospital disinfectant cleaners
Hydrogen peroxide
15% ammonia (85% tap water)
Ammonia-based household cleaners
Household cleaners
Squeeze the cloth thoroughly to remove excess liquid.
3.
Lightly wipe the external casing of the ventilator, taking care not to allow excess moisture to enter any of the openings on the ventilator’s surface. See the warnings in this section.
4.
Dry the ventilator surface with a clean, soft, lint-free cloth.
9.2
Cleaning the Accessories
Follow the accessory manufacturer’s instructions for cleaning the ventilator’s accessories and components, including the patient circuit.
WARNING:
After assembling, cleaning, or reassembling the patient circuit, and on a daily basis, inspect the hoses and other components to ensure that there are no cracks or leaks and that all connections are secure.
WARNING:
Never use a liquid cleaner inside the patient circuit, or on any component of a gas pathway. Clean the patient circuit only as specified by the manufacturer's instructions.
9.3
Cleaning the Ventilator Between Patients
To prepare the ventilator for use with a new patient, do the following:
1.
Change the patient circuit and all filters.
2.
Clean the ventilator. (See section
, “ Cleaning the Ventilator ”)
Clinician's Manual
10 Routine Maintenance
WARNING:
On a DAILY basis, inspect the patient circuit to ensure that it shows no signs of damage, is properly connected, and is operating correctly without leakage.
WARNING:
Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only personnel authorized and qualified by Covidien should repair, open or service the ventilator.
10.1
Replacing the Air Inlet Filter
WARNING:
Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. If necessary, replace the filter before the recommended replacement period is over. This is particularly important when the ventilator is installed on a wheelchair, because environmental conditions may cause the filter to become dirty more rapidly.
WARNING:
Failing to replace a dirty air inlet filter, or operating the ventilator without a filter, may cause serious damage to the ventilator.
WARNING:
The air inlet filter is for use on a single patient. It is not reusable; do not attempt to wash, clean, or reuse it.
If the ventilator is used indoors, the condition of the air inlet filter should be checked monthly.
If the ventilator is used outdoors or in a dusty environment, the air inlet filter should be checked weekly and replaced as necessary.
10-1
Routine Maintenance
To replace the air inlet filter:
1.
Hold the filter between your fingers (see
2.
Remove the filter ( Figure 10-1. , item 2) and discard it.
3.
Place the new filter in the device, while ensuring that: a.
b.
The fine particle side of the filter faces outwards, away from the ventilator.
The filter is properly installed in its housing. Proper installation of the filter prevents particles from entering the device.
Figure 10-1. Replacing the Air Inlet Filter
10-2
10.2
Recommended Schedule of Maintenance
Consumables and Replacement Intervals
When used under normal circumstances—a relatively dust-free atmosphere, and without damage to the device and its components (shocks, cracks, significant dirt)—the intervals for replacing the ventilator’s consumable elements are as follows:
Elements
Air inlet filter
Table 10-1. Consumables and Replacement Intervals
Recommended replacement intervals
Once a month or more often, depending on the extent of soiling
(foam + fine particle)
Inspiratory bacteria filter
Patient circuit
See manufacturer’s recommendation
See manufacturer’s recommendation
Single use, single patient
Note:
For a list of parts and accessories, see Appendix
H , “ Parts and Accessories ” or contact your service
representative or consult www.covidien.com/rms/.
Clinician's Manual
Recommended Schedule of Maintenance
Note:
For all additional accessories not necessarily considered as consumables, consult the manufacturer’s recommendations.
Note:
To prevent any risk of cross contamination, Covidien recommends the use of STERIVENT filters (Ref: 351/
5856 or equivalent) to protect the patient outlet port.
WARNING:
Regularly check the cleanliness of the air inlet filter located on the rear of the ventilator. Replace it when necessary— even before the recommended replacement period has elapsed, and particularly when the ventilator is installed on the wheelchair. Environmental conditions may cause the filter to become dirty more rapidly.
Failure to observe these recommendations may result in a loss of performance, excessive overheating, a loss of certain functions and, in the long term, compromise the longevity of the ventilator.
Maintenance of the Internal Battery
The internal battery does not need to be removed to verify its correct operation.
Periodic Test of the Internal Battery
Your ventilator continuously and automatically checks the state of the internal battery, even when the internal battery is not used as the main power source.
However, the battery charge status should be checked MONTHLY by disconnecting the ventilator from external power supplies (see section
, “ Battery Operation ”). Such a test is imperative after
opening the ventilator or after a prolonged period of non-use (1 month or more), in order to ensure the correct operation of internal connections linking the battery to other components.
WARNING:
The maximum recommended shelf life of the internal battery is two (2) years. Do not use a battery that has been stored for two years or more prior to its first use.
WARNING:
Periodic recharging is important to help maximize useful life of the battery. Do not store the internal battery for extended periods, without recharging, as this may reduce the maximum life.
Replacement of the Internal Battery
The internal battery should be replaced when the battery capacity drops below 1920 mAh. Keep in mind that, for environmental protection, the ventilator and its components—including its internal battery—cannot be disposed of with household waste. You must submit the ventilator and its components for suitable selective collection and possible recycling and observe all applicable regulations.
Clinician's Manual 10-3
Routine Maintenance
Note:
As the total number of battery charge/discharge cycles approaches 300, a drop in potential of as much as
20% may be detected.
10.3
Service Assistance
WARNING:
If a problem with the ventilator is suspected, FIRST CHECK THAT THE PATIENT IS NOT IN DANGER.
If necessary, remove the patient from the ventilator and provide an alternative means of ventilation.
WARNING:
Do not attempt to open, repair or otherwise service the ventilator yourself. Doing so might endanger the patient, damage the ventilator, and/or void your warranty. Only qualified service personnel should open, repair or service the ventilator.
In the event of a problem with the ventilator, see Chapter
, “
.” If you cannot determine the cause of the problem, contact your equipment supplier or Covidien.
For more information and local Covidien Technical Service contact details, see “
”
10-4 Clinician's Manual
A Patient/Caregiver Checklist
What the Patient and Caregiver Must Understand
Table A-1. presents a summary of the topics that patients and caregivers must understand in
order to use the ventilator successfully. Some topics may not apply to some patients, while other patients may require additional information.
The Clinician’s Responsibility
It is the responsibility of the clinician or clinical educator to ensure that both the patient and the caregiver fully understand the topics listed below.
List of topics
Need for ventilation.
Intended use of the ventilator.
Table A-1. Patient/Caregiver Checklist
References
Clinician
Chapter
The principles of operation for the ventilator.
Supplies required for ventilation, and their sources.
Schedule for ventilation.
How and why to monitor the patient’s condition.
The importance of coordinating care for the patient.
Appendix
Clinician; Appendix
G , “ Unpacking and Preparation ;” Appendix
Clinician
Clinician
Clinician
Resources for respite care.
Choices about future care.
The purpose of advanced directives.
How to check the patient’s vital signs.
Clinician
Clinician
Clinician
Clinician
The significance of the patient’s ease of breathing.
Clinician
What to note about the patient’s skin, mucus membranes, and secretions, and their significance.
How to recognize the signs of infection, and how to respond.
Clinician
Clinician
Whom to contact for medical emergencies, equipment emergencies, or power emergencies.
Clinician; section
, “ Troubleshooting ;” section
A-1
Patient/Caregiver Checklist
List of topics
Table A-1. Patient/Caregiver Checklist (Continued)
References
Equipment and phone numbers to have available in cases of emergency.
How to contact other resources for assistance (health aides, attendants, therapists).
The importance of routine medical appointments and medical testing.
Clinician
Clinician
Power sources for the ventilator and how to connect them.
, “ Connecting to External AC Power
” and
, “
Connecting to an External DC Power
The meaning of keys and buttons.
The meaning of symbols and markings.
How to connect the patient to the ventilator via the patient breathing circuit.
The parts and purpose of the breathing circuit.
”
How and when to inspect, clean, and replace the patient circuit.
, “
”
, “
”; Chapter
How to recognize and respond to problems with the breathing circuit.
The parts and purpose of the nasal interface or mask.
, “
Clinician or manufacturer’s instructions for use.
Care of the nasal interface or mask.
How to recognize and respond to problems with the nasal interface or mask.
How to install the humidifier.
Clinician or manufacturer’s instructions for use.
Clinician or manufacturer’s instructions for use.
”
How to perform alarms tests, and how to respond if the alarms tests fail.
, “
“ Alarms and Troubleshooting ”
Replacement interval for outlet filters (per the filter manufacturer’s instructions).
, “
Recommended Schedule of Maintenance ”
Setting ventilation parameters and the importance of each.
Ventilator alarm settings; understanding the purpose and function of each.
, “
”
”
Recognizing alarm priority level.
What to do in case of ventilator alarms and problems.
, “
What to do if the ventilator alarms inappropriately.
The oxygen setting, and why it is required.
How to connect the oxygen source to the ventilator.
Clinician
A-2 Clinician's Manual
List of topics
Table A-1. Patient/Caregiver Checklist (Continued)
References
How to determine the quantity of oxygen being delivered, and how to adjust the quantity.
”
Safety rules for the use of oxygen.
Chapter
, “
“
How to recognize and respond to problems with the oxygen supply.
Clinician
How to respond to dyspnea.
Clinician
Techniques to prevent aspiration of vomit.
Clinician
Clinician's Manual A-3
Patient/Caregiver Checklist
Page Left Intentionally Blank
A-4 Clinician's Manual
B Specifications
B.1
Physical
Ventilator weight
Ventilator dimensions
Table B-1. Physical Description (Excluding Accessories)
9.9 lb. (4.5 kg)
Connectors
9.25 in wide x 12.40 in deep x 6.0 in high
(235 mm wide x 315 mm deep x 154 mm high)
Inspiratory limb connector: ISO 22 mm (OD) conical
Oxygen inlet: female connector with valve
2000 ml Device airway volume
Breathing circuit volume
• Adult, single limb
• Pediatric, single limb
Air inlet filter
550 ml
300 ml
Inspiratory bacteria filter requirement
Dimensions: 70 mm long x 60 mm wide
Composition: Polypropylene fiber electrostatic filter material, which is laminated onto polyurethane open-celled foam.
Efficiency: 99.999982% at 30 lpm (filtering microbes 3.3 μm)
Maximum allowable flow resistance: 4 mbar at 60 lpm
B.2
Electrical
100 VAC to 240 VAC 50 Hz/60 Hz
12 VDC N/A
30 VDC
Voltage
Table B-2. AC Electrical Supply
Frequency Consumption
N/A
180 VA max
8.3 A
3.3 A
B-1
Specifications
Voltage
Full-load capacity
Ampere-hour rating
Table B-3. Internal Lithium Ion Battery
25.2 VDC
2.4 Ah
Watt hour rating
Charging current
Standby mode
Ventilation mode
On standby: 1.5 Ah
During ventilation: 0.5 Ah
62Wh to 63Wh
1.5 A/hr. (duration: <4 hr.)
0.5 A/hr. (duration: <8 hr.)
Average operating time at 25°C (± 5ºC) with a fully charged battery (having less than 50 charge/discharge cycles) at the following displayed values:
Vt = 200 ml (±5 ml), PIP = 10 mbar (±2 mbar), Rate = 20 bpm
Vt = 300 ml (±5 ml), PIP = 20 mbar (±2 mbar), Rate = 15 bpm
Vt = 500 ml (±5 ml), PIP = 30 mbar (±2 mbar), Rate = 15 bpm
Vt = 750 ml (±5 ml), PIP = 45 mbar (±2 mbar), Rate = 20 bpm
(maximum settings)
5 hr. (–10%)
4 hr. (–10%)
3 hr. (–10%)
2 hr. (–10%)
Table B-4. Remote Alarm
Remote alarm port: Also known as the nurse call port, it provides for remote alerts of ventilator alarm conditions.
An example of a setting that requires such a feature is when the ventilator is used in an isolation room. The ventilator signals an alarm using a normally open (NO) or a normally closed (NC) signal.
A remote alarm is activated when an alarm condition occurs, unless the audio paused function is active or the ventilator power switch is turned off.
The alarm delay, once generated from the ventilator, to the nurse call output/input cable connectors is less than 100 ms.
The remote alarm port is an 8-pin female connector. Allowable current is 100 mA at
24 VDC (maximum).
Nurse call pin-out
(view from back of ventilator)
4
5
6
Pin
1
2
3
7
8
Signal relay common normally open (NO) normally closed (NC) remote supply—(not used)
RX signal (not used)
TX signal (not used) remote supply + (not used) not used
Remote alarm wire color black brown orange
N/A
N/A
N/A
N/A
N/A
B-2 Clinician's Manual
Indicators and Alarms
B.3
Indicators and Alarms
Ventilation ON/OFF
• Blue in standby mode
• Not lit if ventilation is in progress
Table B-5. Power Indicators
AC power DC power Internal battery
Green Green • Flashing if the battery charge is in progress
• Continuously lit if the ventilator is powered by the internal battery
Table B-6. Alarm Indicators
High priority Medium priority
Red flashing LED Yellow flashing LED
Table B-7. Audio Alarms
Audio paused Alarm volume
60 s ±1 s 65 to 80 dB (A) ±10% at 1 meter
B.4
Performance
B.4.1
Specifications
Table B-8. Performance Parameter Specifications and Tolerances
1
Pressure
Time
Rate
Inspiratory Sensitivity
Exhalation Sensitivity
I:E Ratio
I/T Ratio
5 to 55 mbar
0.3 to 6.0 s
1 to 60 bpm
0P to 5
5 to 95%
1:4 to 1:1
20% to 50%
±(1 mbar +10%)
± 10%
±1 bpm
N/A
± (4 lpm +10% of target exhalation flow) based on E Sens within 50ms
Insp. time ±50 ms and Exh. time ±50 ms or I:E ratio ±10%, whichever is greater
Insp. time ±50 ms and Exh. time ±50 ms or I/T ratio ±10%, whichever is greater in The ventilator parameters’ displayed values could vary based on patient settings.
Clinician's Manual B-3
Specifications
B.5
Monitored Parameters
Table B-9. Monitored Parameter Tolerances
Ventilator Parameters
Peak Inspiratory Pressure (PIP)
Tolerances
± (2 mbar + 8%)
Positive End Expiratory Pressure (PEEP)
1
Inspiratory Tidal Volume (VTI)
± (2 mbar + 8%)
Total Breath Rate (Rtot)
I:E Ratio (I:E)
I/T Ratio (I/T)
Inspiratory Time (I Time)
Inspiratory Minute Volume (M VoI)
± (10 ml + 10%) and ±(20 mL + 20%) in CPAP mode above 200 ml or in NIV configuration
±1 bpm
Insp. time ±50 ms and Exh. time ±50 ms or I:E ratio ±10%, whichever is greater
Insp. time ±50 ms and Exh. time ±50 ms or I/T ratio ±10%, whichever is greater
± 100 ms
±(10 mL + 10% VTI) x Rate (with exhalation valve) and ±(20 mL + 20% VTI) x Rate in NIV configuration (without exhalation valve)
Leak
Apnea Index (AI)
Apnea Time
% Spontaneous (Spont)
Peak Airway Pressure (Paw)
± (3 lpm + 20%)
± 1 ev/h
± 1 s
± 1%
± (2 mbar + 8%) in The Puritan Bennett™ 520 Ventilator does not have the capability to reduce pressure below the PEEP pressure during the exhalation phase.
B.6
Range, Resolution, and Accuracy
patient data.
Ventilator settings
Mode
Vt Target
Table B-10. Ventilator Range, Resolution, and Accuracy
Range, resolution, and accuracy
Range: P A/C, PSV, CPAP
Resolution: N/A
Accuracy: N/A
Default value: P A/C
Range: 50 mL to 2000 mL
Resolution: 10 mL
Accuracy: Vt target < VTI < Vt target +20% if Max P is high enough to reach Vt target
Default value: OFF (100 mL)
B-4 Clinician's Manual
Range, Resolution, and Accuracy
Ventilator settings
Inspiratory Pressure
(Pi)
Pressure support (P Support)
Table B-10. Ventilator Range, Resolution, and Accuracy (Continued)
Range, resolution, and accuracy
Range: 5 mbar to 55 mbar in valve configuration
Range: 6 mbar to 30 mbar in leak configuration
Resolution: 1 mbar
Accuracy: ±(1 mbar + 10%) of Pi + PEEP setting
Default value: 15 mbar
Depends on: PEEP when Relative Pressure is set to YES
I:E Ratio (I:E)
I/T Ratio (I/T)
Inspiratory time (Insp Time)
Respiratory rate (R-Rate)
Inspiratory sensitivity (I Sens)
Exhalation sensitivity (E Sens)
Range: OFF or 5 mbar to 55 mbar in valve configuration
Range: 6 mbar to 30 mbar in leak configuration
Resolution: 1 mbar
Accuracy: ±(1 mbar + 10%) of P Support + PEEP setting
Default value: 15 mbar
Depends on: PEEP when Relative Pressure is set to YES
Range: from 1:1 to 1:4
Resolution: 1/0.1
Accuracy: Insp. time ±50 ms and Exh. time ±50 ms or I:E ratio ±10%, whichever is greater
Default value: 1/2
Range: 20% to 50%
Resolution: 1%
Accuracy: Insp. time ±50 ms and Exh. time ±50 ms or I/T ratio ±10%, whichever is greater
Default value: 33%
Range: 0.3 s to 6.0 s
Resolution: 0.1 s
Accuracy: ±10%
Default value: 1.5 s
Depends on: R-Rate
Range: 1 bpm to 60 bpm in P A/C mode
Resolution: 1 bpm
Accuracy: ±1 bpm
Default value: 13
Range: 0P-5
Resolution: 1
Accuracy: N/A
Default value: 2 in CPAP, I Sens is set to 2 and is not adjustable
Range: 5% to 95% of peak flow
Resolution: 5%
Accuracy: ±(4 lpm +10% of target exhalation flow) based on E Sens within 50 ms
Default value: 25%
In CPAP, E Sens is fixed at 25% and is not adjustable.
Clinician's Manual B-5
Specifications
Ventilator settings
PEEP
Rise time
Backup rate
Apnea time
Table B-10. Ventilator Range, Resolution, and Accuracy (Continued)
Range, resolution, and accuracy
Range: OFF (0.5 mbar) to 20 mbar
Resolution: 1 mbar
Accuracy: ±(1 mbar + 10%) mbar
Default value: OFF
Depends on: Pi in P A/C and PSV modes when Relative Pressure is set to YES
Minimum Inspired Tidal Volume (Min VTI)
Maximum Inspired Tidal Volume (Max VTI)
Maximum Respiratory Rate (Max Rtot)
Minimum Inspiratory Time (Min I time)
Maximum Inspiratory Time (Max I time)
Range: 1-4
Resolution: 1
Default value: 2
Depends on: Insp time
Range: 4-40 bpm
Resolution: 1 bpm
Default value: 13
Depends on: Min I time
Range: AUTO or 1-60 s
Resolution: 1 s
Default value: AUTO
Depends on: Backup R
In PSV, Apnea time: AUTO = 60/Backup R
In CPAP, Apnea Time: AUTO = 30
Range: 30 mL to 2000 mL
Resolution: 10 mL
Default value: 300
Depends on: Max VTI
Range: 80 mL to 3000 mL
Resolution: 10 mL
Default value: 2000 mL
Depends on: Min VTI
Range: 10 bpm to 70 bpm
Resolution: 1 bpm
Default value: OFF
Depends on: R-Rate
Range: 0.1 to 2.8s
Resolution: 0.1 s
Default value: AUTO (Rise time + 300 ms)
Depends on: Max I Time, Backup R, Rise time
Range: 0.8 to 3 s
Resolution: 0.1 s
Default value: AUTO (minimum of 3 s or 30/Monitored rate)
Depends on: Min I Time, R-Rate
B-6 Clinician's Manual
Environmental
B.7
Environmental
The following environmental conditions shall be observed:
Temperature
-40° C to +70° C
(-40°F to +158 °F)
Table B-11. Environmental Conditions for Storage or Transport
Humidity Atmospheric pressure Altitude
10% to 95% RH 500 hPa to 1060 hPa
(7.2 psi to 15.4 psi)
-152 m to 3964 m
(-500 ft to 13 000 ft)
Temperature
+5°C to 40°C
(+41 °F to104 °F)
Table B-12. Environmental Conditions for Operation
Humidity
10% to 95% RH
Atmospheric pressure Altitude
600 hPa to 1100 hPa
(8.7 psi to 16.0 psi)
-152 m to 3964 m
(-500 ft to 13 000 ft)
Under extreme conditions of use, within the limits of a supply voltage of –20% and temperature ranging from normal to 45°C (113°F) with ≤75% RH, the ventilator should not malfunction or endanger the user. However, operating the device for prolonged periods or repeatedly under such extreme conditions could result in premature aging of components and more frequent maintenance.
B.8
USB
Characteristics
USB compatibility
Memory file format
Number of files
USB size
Ventilator data description
Trends capacity
Events capacity
Monitoring capacity
Table B-13. USB Memory Device Specifications
Supported formats
USB flash memory USB 2.0 or USB 1.1
USB 32 bit format (sector size: 512-2048 bytes)
Maximum 999
128 MB to 4 GB
Table B-14. Data Transfer Characteristics
Capacity
86 MB
512 KB or 5500 events
42 MB/48 hours
Clinician's Manual B-7
B-8
Specifications
B.9
Pneumatic
Table B-15. Airway Resistances
Inspiratory
1.0 mbar at 30 lpm flow ±0.1 mbar
3.7 mbar at 60 lpm flow ±0.1 mbar
Exhalation
0.5 mbar at 30 lpm ± 0.1 mbar
1.1 mbar at 60 lpm ± 0.1 mbar
Table B-16. Air Inlet Resistance (Filter)
1.1 cmH
2
0 (1.079 mbar) at 30 lpm flow ±0.1 cmH
2
O
Maximum pressure
50 kPa (7 psi)
Table B-17. Oxygen Inlet Specifications
Maximum flow (See Table B-8. , Performance
Parameter Specifications and Tolerances )
15 lpm
Table B-18. Performance Specifications
Working pressure Sound pressure level
Maximum pressure limit
Internal compliance (ventilator)
5 mbar – 55 mbar 30 dBA (per NF EN
ISO 17510-1 test conditions)
60 mbar 0.0001 l/mbar
Inspiratory triggering response time (Ttr)
100 ms
B.10
Manufacturer’s Declaration
The following tables, Table B-19.
through
Table B-23. , contain the manufacturer’s declarations for
the ventilator’s electromagnetic emissions, electromagnetic immunity, and recommended separation distances between the ventilator and portable and mobile RF communications equipment, as well as a list of compliant cables.
WARNING:
The Puritan Bennett™ 520 ventilator requires special precautions for electromagnetic compatibility and should be installed and started according to the recommendations found in
, “
Specifications .” In particular, the use of nearby mobile and portable communications
equipment using radio frequencies, such as mobile telephones or other systems exceeding the
levels set in the IEC 60601-1-2 standard, may affect its operation. Refer to section B.10
“ Manufacturer’s Declaration .”
WARNING:
The use of any accessory other than those specified, with the exception of the power supplies or cables sold by Covidien, may lead to an increase in electromagnetic emissions or a decrease in the equipment protection against electromagnetic emissions. If the ventilator is used adjacent to such
Clinician's Manual
Manufacturer’s Declaration accessories or stacked with such devices, the ventilator’s performance should be monitored to verify normal operation.
The Puritan Bennett 520 Ventilator is intended for use in the electromagnetic environment specified below.
The customer or the user of the ventilator should assure that it is used in such an environment.
RF emissions
CISPR 11/EN 55011
Table B-19. Electromagnetic Emissions
Group 1 The ventilator uses RF energy only for its internal functions. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.
RF emissions
CISPR 11/EN 55011
Harmonic emissions
IEC/EN 61000-3-2
Voltage fluctuations/ flicker emissions
IEC/EN 61000-3-3
Class B
Class A
Complies
The ventilator is suitable for use in all establishments including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.
Immunity test
Table B-20. Electromagnetic Immunity
The ventilator is intended for use in the electromagnetic environment specified below. The customer or the user of the ventilator should ensure that it is used in such an environment.
IEC / EN 60601 test level Compliance level Electromagnetic environment–guidance
Electrostatic discharge
(ESD)
IEC/EN 61000-4-2
±6 kV contact
±8 kV air
±6 kV contact
±8 kV air
Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.
Electrical fast transient/ burst
IEC/EN 61000-4-4
Surge
IEC/EN 61000-4-5
±2 kV for power supply lines
±1 kV for input/output lines
±1 kV lines/lines
±2 kV lines/earth
±2 kV for power supply lines
±1 kV for input/output lines
±1 kV lines/lines
±2 kV lines/earth
AC power (“mains”) quality should be that of a typical commercial or hospital environment.
AC power (“mains”) power quality should be that of a typical commercial or hospital environment.
Clinician's Manual B-9
Specifications
Table B-20. Electromagnetic Immunity (Continued)
The ventilator is intended for use in the electromagnetic environment specified below. The customer or the user of the ventilator should ensure that it is used in such an environment.
Voltage dips, short interruptions and voltage variations on power supply input lines
IEC/EN 61000-4-11
@ 5% UT
(# 95% dip in UT for 0.5 cycle)
40% UT
(60% dip in UT for 5 cycles)
70% UT
(30% dip in UT for 25 cycles)
@ 5% UT
(# 95% dip in UT for 0.5 cycle)
40% UT
(60% dip in UT for 5 cycles)
70% UT
(30% dip in UT for 25 cycles)
AC power (“mains”) power quality should be that of a typical commercial or hospital environment. If the user of the ventilator requires continued operation during power mains interruptions, it is recommended that the ventilator be powered from an uninterruptible power supply or a battery.
Power frequency (50/60
Hz) magnetic field
IEC/EN 61000-4-8
@ 5% UT
(# 95% dip in UT for 5 s)
3 A/m
@ 5% UT
(# 95% dip in UT for 5 s)
3 A/m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.
Note:
UT is the AC mains voltage prior to application of the test level.
B-10 Clinician's Manual
Manufacturer’s Declaration
Immunity test
Table B-21. Electromagnetic Immunity—Conducted and Radiated RF
The ventilator is intended for use in the electromagnetic environment specified below. The customer or the user of the ventilator should assure that it is used in such an environment.
IEC/EN 60601-1-2 test level
Compliance level Electromagnetic environment– guidance
Portable and mobile RF communications equipment should be used no closer to any part of the ventilator, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter.
Recommended separation distance
Conducted RF
IEC/EN 61000-4-6
3 Vrms
150 kHz to 80 MHz outside
ISM bands
1
3 Vrms
150 kHz to 80 MHz outside
ISM bands
10 Vrms inside ISM bands
1
10 Vrms inside ISM bands d = 0.35√P d = 1.2√P
Radiated RF
IEC/EN 61000-4-3
10 V/m 80 MHz to 2.5 GHz
10 V/m 80 MHz to 2.5 GHz d = 1.2√P80 MHz to 800 MHz d = 2.3√P 800 MHz to 2.5 GHz where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m).
2
Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey,
3
should be less than the compliance level in each frequency range.
4
Interference may occur in the vicinity of equipment marked with the following symbol:
Clinician's Manual B-11
Specifications
Table B-21. Electromagnetic Immunity—Conducted and Radiated RF (Continued)
The ventilator is intended for use in the electromagnetic environment specified below. The customer or the user of the ventilator should assure that it is used in such an environment.
Note:
At 80 MHz and 800 MHz, the higher frequency range applies.
Note:
These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.
in The ISM (industrial, scientific, and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz’; 13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.
cn The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5 GHz are intended to decrease the likelihood that mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas. For this reason, an additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in these frequency ranges.
an Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the ventilator is used exceeds the applicable RF compliance level above, the
Puritan Bennett 520 Ventilator should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the Puritan Bennett 520 Ventilator.
'n Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 10 V/m.
Table B-22. Recommended Separation Distances
The ventilator is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the ventilator can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ventilator as recommended below, according to the maximum output power of the communications equipment.
Separation distance according to frequency of transmitter
Rated maximum output power of transmitter (W)
150 kHz to 80 MHz (outside ISM bands) d = 0.35 √P
150 kHz to 80 MHz
(in ISM bands) d = 1.2 √P
80 MHz to 800 MHz d = 1.2 √P
800 MHz to 2.5 GHz d = 2.3 √P
0.01
0.1
1
10
0.035 m
0.11 m
0.35 m
1.1 m
0.12 m
0.38 m
1.2 m
3.8 m
0.12 m
0.38 m
1.2 m
3.8 m
0.23 m
0.73 m
2.3 m
7.3 m
B-12 Clinician's Manual
Manufacturer’s Declaration
Table B-22. Recommended Separation Distances (Continued)
100 3.5 m 12 m 12 m 23 m
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be determined using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.
Note:
At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
Note:
The ISM (industrial, scientific, and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz;
13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.
Note:
An additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in the
ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5 GHz to decrease the likelihood that mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas.
Note:
These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.
Table B-23. Compliant Cables and Accessories
Cable or accessory
UK AC power cable assembly
Maximum length
1.8 m (5.9 ft)
Japan AC power cable assembly
China AC power cable assembly
South Africa AC power cable assembly
India AC power cable assembly
1.8 m (5.9 ft)
1.8 m (5.9 ft)
1.8 m (5.9 ft)
1.8 m (5.9 ft)
Australia AC power cable assembly
Europe AC power cable assembly
Canada AC power cable assembly
Nurse call cable
12V DC car adapter cable
Oxygen inlet connector -
1.8 m (5.9 ft)
1.8 m (5.9 ft)
1.8 m (5.9 ft)
5 m (16.4 ft)
5 m (16.4 ft)
Clinician's Manual B-13
Specifications
B.11
Standards Compliance and IEC Classification
•
•
•
•
General Standards
Medical Electrical Equipment: General Requirements for Safety IEC 60601-1:1988 and all its amendments up to 1995 and EN 60601-1:1990.
The ventilator will be constructed to comply with the following product Classifications as detailed in
Clause 5 of 60601-1:
– Class II Equipment
– Internally Powered Equipment
– Type BF Applied Parts
– IP31 with respect with respect to access to hazardous parts and ingress of moisture
– Not suitable for use in the presence of flammable anesthetic mixtures
– Not suitable for sterilization
– Suitable for continuous operation
– Detachable power supply cable
Supplement No. 1-94 to CAN/CSA-C22.2 No. 601.1-M90 - Medical Electrical Equipment - Part 1: General
Requirements for Safety.
UL 60601-1 Medical Electrical Equipment - Part 1: General Requirements for Safety: 2003.
•
•
•
•
Collateral Standards
Medical Electrical Equipment - Part 1: General Requirements for Safety -2- Collateral standard Electro-
Magnetic Compatibility requirements and tests IEC 60601-1-2:2007 and EN 60601-1-2: 2007.
Medical Electrical Equipment - Part 1: General Requirements for Safety -2- Collateral standard: Programmable Electrical Medical Systems IEC 60601-1-4:2000 and EN 60601-1-4:2004.
Medical Electrical Equipment - Part 1: General Requirements for Safety -2- Collateral standard: Usability
IEC 60601-1-6:2006 and EN 60601-1-6:2007.
General Requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems IEC 60601-1-8:2006 and EN 60601-1-8:2007.
•
•
Particular Standards
Lung Ventilator for Medical Use-Particular Requirements for Basic Safety and Essential Performance
Part 6: Home-care ventilatory support devices EN ISO 10651-6: 2009.
Lung Ventilators for Medical Use- Particular Requirements for Basic Safety and Essential Performance
Part 1: Home Care Ventilator Support YY 0600.1-2007 (ISO 10651-6:2004, MOD).
B-14 Clinician's Manual
Standards Compliance and IEC Classification
• Anesthetic and respiratory equipment - Conical connectors - Part 1: Cones and sockets EN ISO 5306-
1:2004.
•
Air Transportation Standards
Environmental Conditions and Test Procedures for Airborne Equipment - RTCA/DO-160:2007.
Clinician's Manual B-15
Specifications
Page Left Intentionally Blank
B-16 Clinician's Manual
C Theory of Operation
C.1
Architecture
The Puritan Bennett™ 520 Ventilator’s gas delivery system is primarily composed of an airflow generator and a three-way valve to control the patient circuit exhalation valve. The flow generator is a low-inertia, micro-turbine driven by a brushless DC electric motor, while the three-way valve is a proportional solenoid valve.
These two actuators are microprocessor-controlled and perform according to specific control algorithms. The microprocessor control circuit receives its data from the various servo-controlled pressure and feedback flow sensors that are built into the ventilator.
An electrical supply management system performs the energy conversion so the device can switch between the three available power sources to provide power to the internal electronics.
A cooling fan helps maintain the proper operating temperature range for the internal environment of the ventilator. This fan is servo-controlled to maintain the proper temperature for the most heat-sensitive of the ventilator’s components.
C.2
Operation
The operation of the device is based on a self-adapting, closed loop drive system. The speed of the flow generator (turbine) is servo-controlled according to the patient pressure signal or the inspired flow signal.
The turbine speed control algorithms themselves are based on equations that vary according to the ventilation modes, settings, and the respiratory cycle phases. Thus, fixing the pressure rise time has an influence on the level of turbine acceleration at the start of the inspiration phase.
The transition between the inspiration phase and expiration phase is controlled by a deceleration or braking algorithm proportional to the pressure difference between the two phases.
The exhalation solenoid valve (three-way valve) is fully closed during the inspiratory phase and is proportionally controlled during the exhalation phase to obtain the bias flow. The speed of the turbine adapts to the exhalation pressure threshold during the entire exhalation phase to maintain the operator-set PEEP.
The flow measurement completes the system by enabling detection of patient inspiratory effort and the triggering of inspiration phases. The flow measurement can also be used to determine the end of the inspiration phase in certain ventilation modes.
C-1
Theory of Operation
The flow measurement is automatically corrected as a function of the atmospheric pressure measured inside the ventilator with the Altitude Compensation feature.
*
The flow and volume are in
Body Temperature Pressure Saturated (BTPS) conditions. This necessitates that periodic inspections for calibrating the sensors be performed by maintenance technicians authorized by Covidien (see the Puritan Bennett 520 Ventilator service manual).
If the Altitude Compensation feature is active, a corrective algorithm is applied to the inspiration flow.
The sensor measurement range is software limited from 600 to 1100 hpa.
A cooling fan is provided to maintain the internal temperature of the ventilator within specified limits and to help ensure proper performance and longevity of the device.
Finally, the various measurement signals used in control and detection are protected and specifically filtered in order to limit any risk of disturbance to the device and possible problem.
C-2
* The Altitude Compensation feature is enabled (set to “YES” on the Setup Screen) by default and should remain at this setting.
Clinician's Manual
Figure C-1. Gas Delivery System
Operation
Clinician's Manual
4
5
6
1
2
3
Air inlet filter
Turbine
Inspiratory filter
Inspiratory tubing
Proximal pressure tube
Exhalation valve
7
8
9
10
11
Exhalation valve exhaust port
Exhalation tubing
LCD display
CPU board
Internal battery
C-3
Theory of Operation
Page Left Intentionally Blank
C-4 Clinician's Manual
D Modes and Breath Types
D.1
Modes of Ventilation
This chapter is a general description of the various modes of ventilation and breath types available with the Puritan Bennett™ 520 Ventilator.
Note:
The default ventilation mode setting is P A/C; for more information, see below.
D.1.1
Assist/Control (A/C) Mode
When set to an Assist/Control mode, machine-initiated breaths are delivered at a clinician-set pressure and rate. If the patient triggers a spontaneous breath between machine breaths, the ventilator will deliver a breath based on the pressure settings.
Whether initiated by the patient or the ventilator, all breaths are delivered at the same preset pressure.
The name of the Assist/Control mode is P A/C, if the breaths are based on a pressure setting.
D.1.2
CPAP Mode
In CPAP, the ventilator maintains a constant level of pressure in the patient’s airway.
D.1.3
PSV Mode
PSV mode maintains a constant level of pressure in the patient’s airway during exhalation. In addition, the ventilator applies a clinician-set pressure (Pressure Support) to each of the patient’s breaths. This has the same benefits as CPAP, with the additional benefit of assisting the patient in moving gas into his or her lungs.
D.2
Breath Types
•
The following breath types are available from the ventilator:
Pressure controlled breaths in Assist/Control mode (in P A/C)
D-1
Modes and Breath Types
•
• Pressure-supported breaths in PSV mode
CPAP
D.2.1
Pressure Control Breaths in Assist/Control Mode
In Assist/Control mode (P A/C), each delivered breath will maintain the selected pressure (Pi) maintained over the selected inspiratory time. Inspiration is triggered by patient-generated flow
(for assisted breaths) or by the ventilator (for controlled breaths; breath rate [R-Rate] is the controlling parameter). For both controlled and assisted breaths, the inspiratory pressure is limited to the pressure (Pi) setting, and is cycled by time.
The shape of the pressure waveform depends on the setting of the pressure rise time (Rise Time).
Figure D-1. Flow Patterns in P A/C Mode
D-2 x y1 y2
Time
Airway pressure
Flow
1
2
Start of inspiration
End of inspiration
P A/C mode guarantees a maximum period between breaths, as determined by the Breath Rate
setting. In Table D-1. , the ventilator delivers a controlled (machine) breath, and calculates the
time before another controlled breath must be delivered. The ventilator delivers a second controlled breath at the conclusion of the machine calculated breath time (for simplicity, we will use the term period for “machine-calculated breath time“). Following the second controlled breath, but before another period can elapse, the patient's effort triggers an assisted (or patient-initiated) breath. This restarts the period. At the conclusion of the period, the ventilator delivers another controlled breath.
Clinician's Manual
Figure D-2. Controlled Machine Breaths in P A/C Mode
Breath Types x Time y Airway pressure
1 Period
2
3 Patient-initiated breath
D.2.2
Pressure Supported Breaths in PSV Mode
In PSV mode, the supported breaths maintain the selected pressure (P Support). Inspiration is triggered by patient-generated flow. The inspiration is terminated when inspiratory flow drops to the
Exhalation Sensitivity (E Sens) setting.
The shape of the pressure waveform depends on the setting of the pressure rise time (Rise Time).
See
Figure D-3. Pressure Supported Breaths in PSV Mode x Time y Flow
D.2.3
CPAP
In Continuous Positive Airway Pressure (CPAP) the ventilator maintains pressure at the selected
PEEP over the entire breath cycle. Inspiration is triggered by patient-generated flow. Inspiration is
Clinician's Manual D-3
Modes and Breath Types limited by the pressure and is cycled by the patient when inspiratory flow drops to the Exhalation
Sensitivity threshold (E Sens = 25%). See Figure D-4.
Figure D-4. Flow Patterns in CPAP Mode
D-4
1 Start of inspiration y2 Flow
2 End of inspiration
D.3
Ventilation Modes and Apnea
In PSV mode, the back-up rate is activated so that the ventilator will automatically begin to deliver breaths at the breath rate (Backup R) setting if no patient effort occurs for the Apnea Time setting.
The pressure during a back-up breath is equal to the Pressure Support (P Support) setting before the apnea condition began. If the patient initiates a spontaneous breath while the back-up rate is in effect, the ventilator will return to the previous operating parameters.
In CPAP, a backup rate is not set, but the operator must still set an apnea time (Apnea Time). In that case, the ventilator will sound an APNEA alarm if no breath is triggered by the patient in the apnea time; however, no back up breaths will be generated.
D.4
Vt Target
The Puritan Bennett 520 Ventilator has the Vt Target (Target Volume) feature as a part of pressurebased ventilation modes. This allows a range of pressures to be used to reach a set volume. If the
Clinician's Manual
Vt Target mode is PSV ST or P A/C, Vt Target can be selected within the range of 50 to 2000 mL (or OFF) which controls the inspired tidal volume to the target value specified.
Following each delivered breath, the inspired volume is measured and small pressure adjustments (0.5-2 mbar) are made as necessary to maintain the delivered volume within the target Vt range. If the inspired volume is lower than the target volume, the pressure of the next breath increases a small amount and the inspired volume is measured again.
If the inspired volume is higher than the target volume, the pressure of the next breath is decreased slightly, until the inspired volume matches the target volume. The pressure increases stop if the maximum inspiratory pressure is reached.
Figure D-5. Target Volume in Pressure Modes
Clinician's Manual x y1 y2
Cycle number
Vt (ml)
PIP (mbar, cmH
2
0, or hPa)
1
2
3
Vt target
Max P
Pi/P support
Cycle number
Pi set point
(cmH
2
O, mbar, or hPa)
Measured
Vti (ml)
20
1
Table D-1. Volume Target Measurements in Pressure Modes
20 +
0.5 =
20.5
380 400
2
1 =
450
3
20.5 +
21.5
4
21.5 +
2 =
23.5
530
=
5
23.5
550
=
6
23.5
7
23.5 -
0.5 =
23
610 580
=
23
490
8 9 10
23 +
0.5 =
23.5
510
=
23.5
520
=
D-5
Modes and Breath Types
Page Left Intentionally Blank
D-6 Clinician's Manual
E Operational Verification Checklist
•
•
•
The operational verification and safety checks listed in
Table E-1. below should be performed
to ensure the ventilator is operating properly in the following circumstances:
Prior to using the ventilator with a patient.
Regularly, according to institutional protocol.
Following maintenance or changes in ventilator settings.
If the ventilator fails any of the safety checks below, or if you cannot complete these checks, see section
, “ Troubleshooting ” on page 5-14 or call the equipment supplier or Covidien (see
section
WARNING:
Provide the patient with an alternate means of ventilation before conducting these tests.
WARNING:
To reduce the risk of infection, wash your hands thoroughly before and after handling the ventilator or its accessories.
3
4
1
2
5
6
7
8
Table E-1. Operational Verification Checklist
Verify the proper appearance and cleanliness of the ventilator.
Verify all of the labels and markings on the ventilator are clear and legible.
Confirm the air inlet filter is clean and correctly installed.
Ensure the AC power cable does not exhibit any signs of damage, such as kinks, breaks, or damaged insulation.
Connect the AC power cable.
Ensure that all power supply indicators on the front panel flash, except for the AC power supply (mains) indicator, which should remain lit.
Push the power switch I/O to the I position to activate the ventilator test:
Check that the two alarm indicators and the Standby indicator (located close to the VENTILATOR ON/
OFF key) flash. Ensure also that the two alarm buzzers sound.
Perform the Functioning Alarms Test regularly according to institutional protocol (see Appendix
Verify the alarm volume is adapted to the patient environment. See section 7.3
, “
Preferences Menu Parameters ” for instructions on changing the alarm volume setting.
Pass
Pass
Pass
Pass
Pass
Pass
Pass
Pass
E-1
Operational Verification Checklist
9
Table E-1. Operational Verification Checklist (Continued)
10 Ensure the patient breathing circuit is correctly attached to the ventilator, with all the necessary components, and is free from any signs of damage and leaks.
Pass
Pass
E-2 Clinician's Manual
F Alarms Tests
Before connecting the ventilator to the patient, perform the following tests to ensure the ventilator‘s alarms are working properly.
WARNING:
Do not perform ventilator alarm tests while the patient is connected to the ventilator. Provide the patient with an alternate means of ventilation before conducting these tests.
WARNING:
If the ventilator fails any alarm test or if you cannot complete these tests, see the
Troubleshooting section (refer to Chapter 5 , “ Alarms and Troubleshooting ”) of this manual or call
your equipment supplier or Covidien (refer to section
, “
Service Assistance ” on page 10-4 ).
WARNING:
The setting of the Min PIP alarm must be adjusted for the patient, but must also be set high enough to allow the PATIENT DISCONNECTION alarm to trigger properly. Perform the Low
Pressure Test (refer to section
, “ Low Pressure Test ” on page F-1 ) to ensure the Min PIP alarm is
properly set.
Note:
Most of these tests require that an approved patient circuit be connected to the ventilator. Ensure that your patient circuit is properly connected prior to performing these tests.
F.1
Low Pressure Test
WARNING:
The setting of the Min PIP alarm must be adjusted for the patient, but must also be set high enough to allow the PATIENT DISCONNECTION alarm to trigger properly. Perform the following test to ensure the Min PIP alarm is properly set.
1.
Before proceeding, set the ventilation and alarm parameters specified by the patient’s clinician and install a single-limb circuit setup.
2.
Press the VENTILATION ON/OFF key to start ventilation.
3.
Keep the patient‘s end of the breathing circuit open and allow ventilation to continue.
F-1
Alarms Tests
4.
Wait for (Apnea time + 2 seconds; Apnea time is not always 5 seconds), then ensure that:
•
• The high priority indicator (red color) lights up
The “PATIENT DISCONNECTION” alarm is shown
• The audible alarm sounds
5.
Press the ALARM CONTROL key once to pause the audible alarm.
6.
Press and hold the VENTILATION ON/OFF key for 3 seconds, then release it. Press the VENTILATION
ON/OFF key again to confirm stop. The ventilator switches to standby mode and cancels the alarms.
F.2
Circuit Check Test
F.2.1
Performing a Circuit Check
Perform a circuit check whenever replacing or altering a patient circuit. Ensure the patient is fully disconnected from the ventilator prior to starting this test.
Note:
Before performing a circuit check, stop ventilation using the VENTILATION ON/OFF key, not the I/O switch. If the I/O switch was used to stop ventilation, the circuit check function cannot be used unless first stopping ventilation using the VENTILATION ON/OFF key.
Press and hold the MENU key during power up to access the circuit check test screen. 1.
Figure F-1. Circuit Check Screen (Before Starting)
F-2
2.
Verify that the proximal pressure tube of the patient circuit is properly connected to the proximal pres-
, “
Patient Circuit ,” on page 6-8 .)
3.
Verify that the exhalation valve tube is connected to the exhalation valve port.
Clinician's Manual
4.
Block the patient connection port of the patient circuit (see
Figure F-2. Blocking the Patient End of a Single-Limb Circuit
Circuit Check Test
5.
Activate the circuit test by pressing the ENTER key.
6.
During the circuit check (which typically takes about 10 seconds to complete), the ventilator will do the following: a.
b.
c.
Sound a short beep
Close the exhalation valve
Show Test Status as RUNNING (see
Figure F-3. Circuit Check (Running)
Clinician's Manual f.
g.
d.
e.
h.
Increase pressure to 30 mbar (±10% with no leak)
Show flow sensor measurement as Leak in Lpm (updated every 2 seconds)
Sound a short beep every time the flow measurement is updated
Sound a long audible beep once the check is complete
Show PASS or FAIL in the Test Status field
F-3
Alarms Tests
Figure F-4. Circuit Check (Complete, Passed)
Figure F-5. Circuit Check (Complete, Failed)
F-4
7.
Review the results. A FAIL result indicates leak(s) of greater than 1 L/min exist.
To rerun circuit check test, press the ENTER key again. To cancel the circuit check while it is running, press the UP , DOWN , ENTER , VENTILATION ON/OFF , or MENU key.
F.2.2
Troubleshooting a Failed Check
If the circuit check fails, do the following:
1.
Ensure an approved circuit is in use. Reference
2.
Check patient circuit connections to the ventilator, examining each for leakage and tightness.
3.
Replace the patient circuit if necessary.
4.
Rerun the circuit check test.
5.
If the failure persists, have the ventilator evaluated by a qualified technician.
Clinician's Manual
Apnea Test
F.3
Apnea Test
Apnea breaths only apply in PSV, and CPAP modes.
1.
Connect the patient end of the patient circuit to a test lung.
2.
Verify that the pressure tube of the patient circuit is properly connected to the appropriate fitting on
both the ventilator and the proximal pressure port (see section 6.4
, “
” on page
).
3.
Press the VENTILATION ON/OFF key to start ventilation.
The ventilator will deliver a mandatory breath. Before the second mandatory breath is delivered, verify that the following events occur:
•
• The medium priority indicator (yellow color) illuminates
The APNEA alarm is shown
• An audible alarm sounds
4.
Press the ALARM CONTROL key twice to reset the alarm.
5.
Press and hold the VENTILATION ON/OFF key for 3 seconds, then release it. Press the VENTILATION
ON/OFF key again to confirm stop.
• Ventilation stops.
F.4
Power Failure Test
Note:
If the ventilator is operating on either the external power supply or the internal battery, you must plug it in to an AC power source before beginning this test.
Disconnect the ventilator from its AC power supply. Ensure that the following events occur: 1.
•
•
•
• The medium priority indicator (yellow color) illuminates
The AC POWER DISCONNECTION alarm activates
An audible alarm sounds
The DC POWER indicator illuminates if the DC power source is connected; otherwise, the INTER-
NAL BATTERY indicator illuminates
2.
Press the ALARM CONTROL key twice to reset the alarm.
3.
Reconnect the ventilator to its AC power supply.
Clinician's Manual F-5
Alarms Tests
F.5
Occlusion Test
1.
Verify that the pressure tube of the patient circuit is properly connected to the appropriate fitting on both the ventilator and the proximal pressure port (see section
, “ Patient Circuit ” on page 6-8
).
2.
Block the exhalation port on the exhalation valve of the patient circuit. See
Figure F-6. Blocking the Patient End of a Single-Limb Circuit
F-6
3.
Press the VENTILATION ON/OFF key to start ventilation.
4.
Allow the ventilator to deliver three consecutive breaths. At the beginning of the fourth breath, ensure that the following events occur:
•
• The high priority indicator (red color) illuminates
The Occlusion alarm activates
• An audible alarm sounds
5.
Press the ALARM CONTROL key to pause the audible alarm.
6.
Unblock the exhalation port.
• The occlusion alarm is canceled.
7.
Press and hold the VENTILATION ON/OFF key for 3 seconds, then release it. Press the VENTILATION
ON/OFF key again to confirm stop.
• Ventilation stops.
Clinician's Manual
Battery Test
F.6
Battery Test
The ventilator is capable of testing the power of the battery (see Chapter
8 , “ Internal Battery ”). You
can determine which power source the ventilator is using by checking the power indicator, located on the top panel. The indicator light will be lit to indicate which power source is currently available.
1.
Disconnect the AC power supply cable and the DC power cable (if it is connected) from the ventilator.
•
• A POWER DISCONNECTION alarm will trigger.
2.
Press the ALARM CONTROL key twice to pause the alarm. Ensure that the following events occur:
The INTERNAL BATTERY indicator to the upper-left of the display illuminates
• The BATTERY symbol is shown at the top of the screen (along with its reserve capacity)
3.
Connect the AC (mains) power supply. Ensure that the following events occur:
•
• The AC POWER indicator to the upper-left of the display illuminates
The indicator to the upper-left of the display is flashing, which indicates that the battery is charging (this only occurs if the ventilator has run on battery power long enough to lose enough charge that the charger will turn on)
• The BATTERY symbol is no longer shown at the top of the screen
F.7
Involuntary Stop Test
To verify proper functioning of the very high priority audible alarm, perform the following steps:
1.
Press the VENTILATION ON/OFF key to start ventilation.
2.
Set the I/O switch to the O (off) position to turn off the ventilator during ventilation. Ensure that the following events occur:
•
• An audible alarm sounds continuously
The ventilator turns off. There should be no alarm indicators illuminated and no alarm messages shown.
3.
Press the ALARM CONTROL key once to pause the audible alarm.
Clinician's Manual F-7
Alarms Tests
Page Left Intentionally Blank
F-8 Clinician's Manual
G Unpacking and Preparation
The Puritan Bennett™ 520 Ventilator is delivered with the following items:
(1) Printed user's manual (language as requested by the customer)
(1) Clinician's manual on CD (a print copy is available upon request by the customer)
(1) Patient circuit and valve
(1) Set of six combination foam/fine particle air inlet filters
(1) Carrying bag
(1) Oxygen connector
(1) AC power cable
WARNING:
Users must always possess an additional circuit and valve while using the Puritan Bennett™ 520
Ventilator.
WARNING:
To minimize the risk of damage, you must use the Dual Bag to transport the Puritan Bennett™
520 Ventilator. Refer to Figure G-2.
To unpack and prepare the ventilator, follow the steps below:
1.
From the plastic bag, remove the following:
•
• Plastic pocket containing the clinician’s manual.
2.
• The ventilator and its components or accessories.
Remove the patient circuit, the AC (“mains”) power cable, and the set of fine-particle air inlet filters .
3.
Inspect the ventilator for the following items:
The ventilator’s outer casing and the I/O switch’s protective cover do not have any dents or scratches, which may indicate possible damage.
•
• The ventilator’s labels and markings are clear and legible.
The AC power cable does not exhibit any signs of damage, such as kinks, breaks, or cuts.
G-1
Unpacking and Preparation
WARNING:
Never use a ventilator or any components or accessories that appear to be damaged. If any signs of damage are evident, contact your equipment supplier or Covidien.
4.
Clean the ventilator with a mild soap solution, if necessary (see Chapter
5.
Ensure that the air inlet filter is installed.
Figure G-1. Puritan Bennett 520 Ventilator
G-2 Clinician's Manual
Figure G-2. Dual Bag
Clinician's Manual G-3
Unpacking and Preparation
Page Left Intentionally Blank
G-4 Clinician's Manual
H Parts and Accessories
Table H-1. provides a list of accessories that are available for the Puritan Bennett™ 520 Ventila-
tor.
To order parts or accessories, contact your equipment supplier or Covidien representative.
Note:
The ventilator is delivered with the following items: a printed user’s manual, a CD with clinician’s manual
(printed copy available upon request), one patient circuit with valve, one set of six combination foam/ fine particle air inlet filters, one carrying bag, one O
2
connector, and one AC power cable.
Description
Carrying bag (grey)
Oxygen inlet connector
Ventilator cart
Dual bag (blue or pink) delivered with:
Backpack padded straps, 2 each
Suspension belt
Carrying belt
WARNING:
Table H-1. List of Consumables and Accessories
To minimize the risk of damage, you must use the ventilator’s Dual Bag to transport the ventilator. See
on page
AC (mains) power cable
DC power cable (for connection to an external DC power source, such as a car 12 volt DC outlet)
Nurse call cable (5 meters)
Inlet air combi-filter, fine (pack of 6)
Note:
This is the “foam plus fine particle” filter listed in Table 10-1. Consumables and Replacement
).
H-1
Parts and Accessories
Table H-1. List of Consumables and Accessories
Description
Internal battery
External battery
3-way DAR™ valve
DAR™ inspiratory bacteria filters
Barrierbac
Barrierbac S
Barrierbac S Angled
Hygrobac
Hygrobac S
Hygrobac S Angled
Hygroboy
Hygroster
Hygroster Mini
Sterivent
Sterivent S
Sterivent Mini
Hygrolife II
Table H-2. provides a list of consumable parts available for the ventilator.
WARNING:
To ensure proper performance of the ventilator, use a patient circuit recommended by Covidien in
this manual; refer to Chapter 6 , “ Installation and Assembly ” and Appendix
.” The total specified length of the patient circuit tubing as measured from the ventilator outlet to the ventilator inlet is 1.1 meters (3.6 ft) to 2.0 meters (6.6 feet). The tubing must conform to all applicable standards and must be fitted with Ø 22 mm terminals that also conform to all applicable standards. Ensure that both the length and the internal volume of the patient circuit are appropriate for the tidal volume: a corrugated tube of Ø 22 mm for adult patients, and a corrugated tube of Ø 15 mm for pediatric patients with a tidal volume lower than 200 ml.
Table H-2. List of Circuits
Description
DAR™ Single-limb patient circuit with exhalation valve, 180 cm, PVC, ADULT
Part Number
5093600
DAR™ Single-limb patient circuit with exhalation valve, 180 cm, PVC, PEDIATRIC
DAR™ Single-limb patient circuit without exhalation valve, 180 cm, PVC, ADULT
5093500
5093300
DAR™ Single-limb patient circuit without exhalation valve, 180 cm, PVC, PEDIATRIC 5093100
For more information regarding parts and accessories for the Puritan Bennett 520 Ventilator, contact your service representative or www.covidien.com/rms/products.
H-2 Clinician's Manual
I Glossary
AC Power
Alternating current.
Alarm Pause
The audible and visual alarms cease and the symbol appears. The symbol will remain until the cause of the alarm is addressed. For example, when the ventilator is running on internal battery, the AC Disconnection alarm may be paused, and the alarm paused symbol will appear until the device is plugged into AC. The paused alarm will be captured in the alarm log screen and can be reactivated.
Alarm Reset
Used only for the High Pressure alarm, this function resets the visual alarm message.
Apnea
The absence of breathing or a breathing pattern capable of supporting an individual's respiratory needs.
Apnea Index (AI)
The apnea index is average number of apnea events per hour of ventilation. It is based on the
Apnea alarm.
Apnea Time
Time allowed between breath starts before APNEA alarm occurs when no patient effort is detected.
Assist/Control
In Assist/Control mode, the ventilator delivers an assisted breath of a set pressure when the patient's breathing effort creates a flow or pressure drop that is greater than the SENSITIVITY setting. In absence of patient breathing effort, the ventilator will deliver a controlled breath of the set pressure. (Does not apply in PSV/CPAP mode).
Assisted Breath
A pressure breath triggered by the patient but then controlled and terminated by the ventilator.
Audio Pause
Pauses the audible alarm for 60 seconds at a time and shows the symbol.
I-1
Glossary
I-2
Back Up Rate
Rate of control cycles in PSV mode during apnea phase.
Battery Level
Display of the remaining battery capacity; located adjacent to the battery symbol.
Bias flow
Turbine flow during exhalation phase through the patient circuit to avoid rebreathing.
bpm
An abbreviation for “breaths per minute,” which is the unit of measure for breath rate (see below).
Breath Rate
The total number of breaths, both machine and spontaneous, delivered by a ventilator in one minute.
Caregiver
An individual who assists a patient with the tasks of daily living. This may be a family member, a live-in assistant, or the nursing staff of a health care facility.
cmH
2
O
An abbreviation for “centimeters of water,” which is a unit of measure for pressure.
Continuous Positive Airway Pressure (CPAP)
Continuous airway pressure maintained throughout a spontaneous breath cycle.
Controlled breath
A pressure breath triggered, controlled and terminated by the ventilator.
DC Power
Direct current.
Exhalation Phase
Phase of the breath cycle during which the patient exhales.
Exhalation Sensitivity
The exhalation sensitivity (E Sens) level is a percentage of peak flow at which a pressure-supported breath will be terminated.
Fraction of Inspired Oxygen (FiO
2
)
Amount of oxygen delivered to the patient.
Flow
Volume of gas delivered by the ventilator compared to time, expressed in liters per minute (lpm).
hPa
An abbreviation for “hectopascal,“ which is a unit of measure for atmospheric pressure.
Clinician's Manual
I:E ratio
Inspiratory time versus exhalation time ratio.
Inspiratory Phase
Phase of the breath cycle during which the patient inspires.
Inspiratory Sensitivity (I Sens)
Level of inspiratory effort the patient has to provide during the initiation of a machine breath. The sensitivity levels (from 0P to 5) correspond to differences in flow compared to the bias flow. Level
0P is the most sensitive (for a pediatric use) and requires the least effort to trigger a breath. Level
5 requires the most amount of effort to trigger a breath.
Inspiratory Tidal Volume (VTI)
Volume delivered to the patient at each inspiratory phase.
Inspiratory Pressure (Pi)
The operator-set inspiratory pressure during a pressure control (PC) mandatory breath.
I Time (Inspiratory Time)
Inspiratory time measure.
Intentional Vent Stop Alarm
Ventilation has been switched off by the user / caregiver and the ventilator is in standby.
I/T Ratio
Inspiratory time versus total breath time ratio.
L liters (a unit of volume).
Leak
When ventilating in leak configuration, it is the average patient/circuit leak during each cycle and over the past 24 hour period.
LED
Light emitting diode; used as indicator lights on the ventilator’s front panel.
lpm
Liters per minute (a unit of volume flow rate).
Machine Hours Counter
Counter for the total ventilation time since manufacture or the last CPU board change.
Mains
AC power supply.
Clinician's Manual I-3
Glossary
Max Leak
The maximum alarm setting of a high leakage threshold. An alarm will be triggered in the event the calculated leakageflow exceeds this limit.
Max Rtot (Total breath rate)
The maximum alarm setting to prevent hyperventilation or ventilator autotriggering. The HIGH
RATE alarm will be triggered if the total breath rate exceeds the maximum limit set.
Max P (Maximum Inspiration Pressure)
Max P allows the ventilator to adjust the inspiratory pressure up to a maximum limit in order to reach the target tidal volume (Vt Target).
Mbar
An abbreviation for “millibar,“ which is a unit of measure for atmospheric pressure.
Mean Airway Pressure
Average patient pressure during each breath.
Minimum Inspiratory Time
Minimum inspiratory time before allowing the patient to exhale.
M Vol (Minute Volume)
Flow delivered at each breath to the patient is measured by the inspiratory flow sensor and that measurement is used to calculate minute volume (Vt x Rtot)
.
P A/C (Pressure Assist /Control)
A ventilator mode which provides machine-initiated breaths delivered at a clinician-set pressure, inspiratory time, and rate.
Patient Breath
Breathing cycle initiated by the patient.
Patient circuit
Tubing between the ventilator and the patient.
Patient effort
Inspiratory effort initiated by the patient.
Patient Hours Counter
Counter of ventilation time for the patient.
Peak Airway Pressure (Paw)
The peak airway pressure is the average peak pressure during the inspiratory phase, measured by each cycle and over the previous 24-hour period.
Peak Inspiratory Pressure (PIP)
The highest pressure measured in the patient circuit during the inspiration phase.
I-4 Clinician's Manual
Positive End Expiratory Pressure (PEEP)
Pressure in the patient circuit at the end of expiration.
Pressure Control (P Control)
Augmentation of the patient's ventilation synchronously with inspiratory effort until a preset pressure is met. Pressure is maintained throughout patient inspiratory flow, and is cycled to expiration by time (controlled by the selected Inspiratory Time setting). Used in Assist/Control mode.
Pressure Support (P Support)
Augmentation of the patient’s ventilation synchronously with inspiratory effort until a preset pressure is met. Pressure is maintained until inspiratory flow is reduced to a percentage of peak flow that depends on the exhalation sensitivity setting for the inspiration, when the ventilator cycles into exhalation.
PSI
Pounds per square inch.
PSV (Pressure Support Ventilation)
Pressure support ventilation.
Rebreathing
The patient breathes his/her exhaled gas.
Respiratory rate
The number of breath cycles (inspiration + expiration) completed within one minute. Normal resting adult respiratory rates are from 12–20 breaths per minute (bpm).
RESTART/SRVC
This is an alarm message. If the message *IF PERSISTS RESTART/SRVC occurs, restart the ventilator.
If the alarm condition is not cleared, call a service representative.
Rise Time
This determines how the target pressure will be reached, and indirectly defines the minimum inspiration time.
Rtot
Parameter measured by the ventilator equal to the total number of breaths per minute (bpm).
Sensitivity
This adjustable parameter determines the amount of inspiratory effort required by the patient before the ventilator delivers an assisted breath, or demands flow in the case of a spontaneous breath.
The Puritan Bennett™ 520 Ventilator is pressure-triggered, with sensitivity levels in the range from
0P to 5: the lower the number, the more sensitive the trigger.
Clinician's Manual I-5
Glossary
Spont Cyc (Spontaneous Cycling)
This is the percentage of ventilation cycles initiated by the patient over the previous 24 hour period.
Standby
The operational mode of the ventilator where it is powered (power supply I/O button set to the
I position), but is not ventilating the patient.
Vent Time (Ventilation Time)
The ventilation duration data is based on the patient counter and shows the total ventilation time in hours and minutes over the previous 24-hour period.
Vt Target (Target volume)
The Vt Target feature enables the ventilator to reach a set volume of gas to be delivered to the patient using a range of pressures in the pressure-based ventilation modes.
I-6 Clinician's Manual
Index
A
AC power
AC power cable
AC POWER DISCONNECTION alarm message . . . . . . . . . . . . . . 5-9, 5-15
Accessories
Air outlet (antibacterial) filter
Air transport
Air transportation standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-15
use on commercial aircraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
Alarm Logs menu
Alarm messages
AC POWER DISCONNECTION . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15
BATTERY FAULT1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9, 5-15, 8-4
BATTERY FAULT2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15
BUZZER LOW BATTERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10
CHECK BATTERY CHARGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-15
CHECK EXH VALVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-16
CHECK EXH VALVE PRESSURE . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-16
CHECK PROXIMAL LINE1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-16
CHECK REMOTE ALARM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-16
CHECK SETTINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-16
CONNECT VALVE OR CHANGE PRESS . . . . . . . . . . . . . . . . . .5-10, 5-16
CONTROLLED CYCLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-16
COOLING FAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10, 5-16
DC POWER DISCONNECTION . . . . . . . . . . . . . . . . . . . . 5-10, 5-17, 6-8
DEVICE FAULT10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
EMPTY BATTERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11, 5-17, 8-4
HIGH INT TEMP COOL VENT . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-18
HIGH LEAKAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-19
HIGH PRESSURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12, 5-20
HIGH/LOW BATTERY TEMP . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-19
INTENTIONAL VENT STOP . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12, 5-20
KEYPAD FAULT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12, 5-21
LOW BATTERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-21, 8-4
NO PROXIMAL LINE2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-21
OCCLUSION CHECK CIRCUIT . . . . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-21
PATIENT DISCONNECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-21
POWER FAULT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-21
POWER SUPPLY LOSS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-22
PRES SENS FLT1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-22
PROX SENS FLT2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-22
REMOVE VALVE CPAP MODE . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-22
REMOVE VALVE OR CHANGE PRES . . . . . . . . . . . . . . . . . . . . 5-13, 5-22
SOFTWARE VERSION ERROR . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13, 5-22
TURB OVERHEAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14, 5-22
UNKNOWN BATTERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14, 5-22
Alarm Parameters
Alarm parameters
Alarm tests
Alarm thresholds
and linked Ventilation parameters . . . . . . . . . . . . . . . . . . . . . . . . . .7-27
Alarms
thresholds, blocking when linked to a ventilation parameter .7-29
Alarms and troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1
Alarms tests
Altitude compensation feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-2
Apnea
and ventilation modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-4
APNEA alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15
Audible alarms
B
Backlight, display
IN-1
Battery
BATTERY FAULT1 alarm message . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15, 8-4
BATTERY FAULT2 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15
Battery, internal
indicator, front panel (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
Blocking an alarm threshold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-29
BUZZER FAULT1 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15
BUZZER FAULT2 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15
BUZZER FAULT3 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9, 5-15
BUZZER LOW BATTERY alarm message . . . . . . . . . . . . . . . . . . . . . . . .5-10
C
Carbon dioxide
risk of inhalation and suffocation . . . . . . . . . . . . . . . . . . . . . . . . . . .7-38
Carrying bag, ventilator (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .G-2
Changing ventilation modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-23
CHECK BATTERY CHARGE alarm message . . . . . . . . . . . . . . . . 5-10, 5-15
CHECK EXH VALVE alarm message . . . . . . . . . . . . . . . . . . . . . . . 5-10, 5-16
CHECK EXH VALVE PRESSURE alarm message . . . . . . . . . . . . 5-10, 5-16
CHECK PROXIMAL LINE1 alarm message . . . . . . . . . . . . . . . . . 5-10, 5-16
CHECK REMOTE ALARM alarm message . . . . . . . . . . . . . . . . . 5-10, 5-16
CHECK SETTINGS alarm message . . . . . . . . . . . . . . . . . . . . . . . 5-10, 5-16
troubleshooting a failed check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-4
Cleaning
Clinician
CONNECT VALVE OR CHANGE PRESS alarm message . . . . . 5-10, 5-16
Connecting to
oxygen supply (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-18
Consumables
Contraindications
CONTROLLED CYCLES alarm message . . . . . . . . . . . . . . . . . . . 5-10, 5-16
COOLING FAN alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10, 5-16
CPAP Mode Menu
D
DC power cable
DC POWER DISCONNECTION alarm message . . . . . . . . 5-10, 5-17, 6-8
DEVICE FAULT 11 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11
DEVICE FAULT10 alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT11 alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT12 alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT13 alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT3 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT5 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT7 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
DEVICE FAULT9 alarm message . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-17
Display
Displayed parameters
E
Electromagnetic compatibility
and mobile/portable communications equipment . . . . . . . . . . . 6-2
Electromagnetic emissions
and use of accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2
EMPTY BATTERY alarm message . . . . . . . . . . . . . . . . . . . . 5-11, 5-17, 8-4
Environment
suitable for use of ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
Environmental specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7
Erase Data, USB Memory Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-35
F
FIO2
oxygen and ventilator settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-15
G
Gas delivery system (diagram) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-3
H
HIGH INT TEMP COOL VENT alarm message . . . . . . . . . . . . . .5-11, 5-18
HIGH LEAKAGE alarm message . . . . . . . . . . . . . . . . . . . . . . . . . .5-11, 5-19
HIGH PRESSURE alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-12, 5-20
IN-2
Index
HIGH RATE alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12, 5-20
HIGH VTI alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12, 5-20
HIGH/LOW BATTERY TEMP alarm message . . . . . . . . . . . . . . .5-11, 5-19
Hot surfaces
I
Indicator
Indicator and alarm specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3
Indicators
INTERNAL BATTERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3, 8-5
Inhalation port closeup (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-11
INTENTIONAL VENT STOP alarm message . . . . . . . . . . . . . . . .5-12, 5-20
Internal battery
charging (Warning) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2, 8-6
maintenance (none required) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3
INTERNAL BATTERY indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5
K
Key sound
KEYPAD FAULT alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12, 5-21
Keys
VENTILATION ON/OFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3
L
Linked ventilation parameters
Liquids
avoid ingress into ventilator (Warning) . . . . . . . . . . . . . . . . . . . . . . 1-4
Locking key
Locking Key and SETUP menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5
Logs menu
LOW BATTERY alarm message . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-21, 8-4
LOW VTl alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12, 5-21
M
Maintenance
option
reserved for service personnel . . . . . . . . . . . . . . . . . . . . . . . . . . .7-11
schedule, recommended . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-2
Manufacturer’s declaration specifications . . . . . . . . . . . . . . . . . . . . . . . B-8
Menu
Preferences, parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-14
Modes ventilation
Monitored parameters
Waveform menu (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
N
NO DATA message, Alarm Logs screen . . . . . . . . . . . . . . . . . . . . . . . . . 5-4
NO PROXIMAL LINE2 alarm message . . . . . . . . . . . . . . . . . . . . 5-12, 5-21
Notes
Nurse call system
connecting the cable to the ventilator . . . . . . . . . . . . . . . . . . . . . .6-23
O
OCCLUSION CHECK CIRCUIT alarm message . . . . . . . . . . . . . 5-12, 5-21
OCCULSION CHECK CIRCUIT alarm message . . . . . . . . . . . . . . . . . . .5-21
Operational verification checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-1
Operator/Users
targeted for use of ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
O-ring, oxygen coupler (Caution) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-18
Oxygen
disconnecting the supply from the ventilator . . . . . . . . . . . . . . .6-18
P
P A/C Mode Menu
IN-3
Parameters
ventilation
Parameters, operating
Inspiratory Tidal Volume (VTI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9
Inspiratory Trigger Sensitivity (I Sens) . . . . . . . . . . . . . . . . . . . . .3-10
Positive End Expiratory Pressure (PEEP) . . . . . . . . . . . . . . . . . . . . 3-9
I Sens (Inspiratory Sensitivity) . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-13
Inspiratory Tidal Volume (VTI) . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-14
Peak inspiratory pressure (PIP) . . . . . . . . . . . . . . . . . . . . . . . . . . .3-12
Positive End Expiratory Pressure (PEEP) . . . . . . . . . . . . . . . . . . .3-12
Respiratory Rate (Rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-13
Inspiratory Tidal Volume (VTI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7
Inspiratory Trigger Sensitivity (I Sens) . . . . . . . . . . . . . . . . . . . . . . 3-4
Min/Max Inspiration Time (Min I Time/Max I Time) . . . . . . . . . 3-6
Positive End Expiratory Pressure (PEEP) . . . . . . . . . . . . . . . . . . . . 3-3
Pressure Support (P Support) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
PSV mode Exhalation sensitivity (E Sens)
Exhalation Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4
Patient
outlet port connections (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-11
length and internal volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-12
replacement interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-2
PATIENT DISCONNECTION alarm message . . . . . . . . . . . . . . . 5-13, 5-21
Patient hours
Patients
targeted for use of ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
Positive end expiratory pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-12
POWER FAULT alarm message . . . . . . . . . . . . . . . . . . . . . . . . . . .5-13, 5-21
POWER SUPPLY LOSS alarm message . . . . . . . . . . . . . . . . . . . .5-13, 5-22
Precautions for use
electromagnetic interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21
Precautions for use, cautions
installation
Precautions for use, warnings
Preference menu
PRES SENS FLT1 alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-13, 5-22
PROX SENS FLT2 alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-13, 5-22
PSV Mode Menu
R
Range, resolution, and accuracy specifications . . . . . . . . . . . . . . . . . B-4
Recharging the internal battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5
REMOVE VALVE CPAP MODE alarm message . . . . . . . . . . . . . .5-13, 5-22
REMOVE VALVE OR CHANGE PRES alarm message . . . . . . . .5-13, 5-22
Repairing the ventilator
qualified personnel only (Warning) . . . . . . . . . . . . . . . . . . . .10-1, 10-3
Replacement intervals
Replacing
S
Safety
onboard alarm system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Service assistance information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4
Setting ventilation parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-25
Setup Configuration
SETUP screen
SOFTWARE VERSION ERROR alarm message . . . . . . . . . . . . . .5-13, 5-22
Specifications
IN-4
Index
manufacturer’s declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-8
monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-4
range, resolution, and accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-4
standards compliance and IEC classification . . . . . . . . . . . . . . . . B-14
Standards, compliance, and IEC classification specifications . . . . B-14
T
Testing
Transfer continuously, USB Memory Device . . . . . . . . . . . . . . . . . . . 7-31
Transfer Trends USB Memory Device . . . . . . . . . . . . . . . . . . . . . . . . . . 7-33
Transport, emergency
ventilator not intended for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
Trigger threshold setting
Troubleshooting
TURB OVERHEAT alarm message . . . . . . . . . . . . . . . . . . . . . . . . .5-14, 5-22
U
UNKNOWN BATTERY alarm message . . . . . . . . . . . . . . . . . . . . .5-14, 5-22
Unpacking and preparing the ventilator . . . . . . . . . . . . . . . . . . . . . . . G-1
USB Memory Device
Transfer continuously . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-31
USB Menu parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-30
V
Ventilation
changing during ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23
changing while on standby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22
VENTILATION ON/OFF key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3
Ventilation parameters
Ventilator
connecting the nurse call cable . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-23
connections, proper (warning) . . . . . . . . . . . . . . . . . . . . . 1-4, 6-2, 6-9
mounting on a wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-20
operation (description of ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-1
patient outlet port connections (figure) . . . . . . . . . . . . . . . . . . . . .6-11
potentially hot surfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-40
symbols and markings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-21
unpacking and preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .G-1
Ventilator, and liquid ingress (Warning) . . . . . . . . . . . . . . . . . . . . . . . . . 1-4
W
Warnings
Waveform menu
monitored parameters (figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
Welcome Menu screen
Wheelchair
mounting the ventilator onto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-20
IN-5
Page Left Intentionally Blank
IN-6
Part No. 10056026 Rev E 2017-05
© 201
1
Covidien.
Covidien llc
15 Hampshire Street, Mansfield, MA 02048 USA
Covidien Ireland Limited, IDA Business and Technology ParkTullamore.
www.covidien.com [T] 1 800 635 5267

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