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1. Balance Gas Gas Inspiratory Expiratory E N3 79 0 x 90 x User Gas 1 Molecular Weight li 0 21 0 x fiso x ips Viscosity Coef aPC C c03 0 0 5 0 x c u Viscosity Intercept PDT e o o 0 0 z in Select Gas None C N50 o o vo x User Gas 2 User Gas 1 t D E Molecular Weight g mole ser Gas z Viscosity Coef MINA User Gas 143 E Viscosity Intercept RP OC Select Gas None Temperature 273 E 273 C AS ieee User Gas 3 IVO EE o x fo Molecular Weight g mole Viscosity Coef MA PIC Viscosity ees oos Viscosity Intercept RP O C Molecular Weight 28 84 g mole 29 44 g mole select Gas None 2 G Air G Respiration wW DK Help Figure 8 23 Gas Calculator Dialog Box VT Plus for Windows Barometric Pressure The VT PLUS automatically calculates the barometric pressure to within 2 of full scale To give greater accuracy the VT PLUS allows the user to calibrate the barometric pressure offset by entering the local barometric pressure into the system The entered value is used to calibrate the system s barometric pressure offset during future use To change the barometric pressure select BAROMETRIC PRESSURE from the SETUP MENU Enter the local barometric pressure in the box provided and click the OK button Barometric Pressure Dialog x Enter Local Barometric Pressure Barometric Pressure mm Hg Figure 8 24
2. 9 E Figure 8 12 Timed Breaks dialog box Use this setting to determine how often an automatic event marker will be placed in the data file Event markers are used with the FORWARD and REVERSE functions of the file paycheck Select the desired time interval between automatic event markers and then select OK Shorter times will allow you to see more of your data during playback The software keeps a timer for the automatic event marker If you the user insert an event by using TIME or ANNOTATE the timer is reset This is to avoid having automatic events too close to user events VT Plus for Windows File Information Panel The File Information Panel of the File Controls Interface is shown below File Information rss 7 51 49 AM Subject Patient 1 Investigator Dr Gas D Man Sample file for the manual Figure 8 13 File Information Panel The first line in the information box contains the open file name The next line is the time that the file was first created The remaining lines contain the information that you the user provided when the file was created Event Panel During file playback the software checks for event markers in the data files The event panel displays information from the data file regarding the last event that was played back This information will remain displayed until another event is reached Generating Signal sig Files A signal file is
3. High Pressure Oxygen Figure 8 18 Selecting a Signal To change the units for a signal select SIGNAL UNITS from the SETUP menu All statistics and plots reflect the current units for the assigned signal VT PLUS Operator s Manual 8 29 10 Zeroing The VT PLUS can be zeroed either automatically or manually Zeroing corrects the flow and pressure sensors for offset to get a more accurate reading To switch the VT PLUS between automatic and manual zeroing select the ZEROING menu from the SETUP menu The current zeroing mode has a check next to its name Select the zeroing mode you want Manual Zeroing When the VT PLUS is in manual zero mode no automatic zeros will occur Periodically it is a good idea to zero the signals on the VT PLUS to null any offset errors in the flow and pressure sensors The VT PLUS has two different ways to perform a manual zero 1 Select ZERO from the menu and then choose to ZERO ALL or select the signal you would prefer zeroing from the given list Setup Help B Zero All Zero Flow Zero Volume Zero Low Pressure Zero High Pressure Zero Oxygen 21 Calibrate Oxygen 100 Figure 8 19 Zeroing Menu 2 Select the ZEROING SPEED button from the tool bar Choose the preferred plot from the given list Just clicking the ZEROING button is the same as selecting ZERO ALL Automatic Zeroing The VT PLUS can be set to automatically zero flow and airway pressure periodically
4. D 5 10 15 20 Monitor Screen Single Plot Screen 4 Loop Screen A Full Test Stacked Volume Test FILE C Program FilestTPlusiSignalst Literaves vtp Figure 8 3 Monitor screen VT Plus for Windows Single Plot Screen The Single Plot Screen allows you to observe one of the signals The plot can be configured to display any of the signals flow volume airway pressure low pressure high pressure and oxygen This plot can be set to auto scale or it can be manually re scaled to the user s desired range of values On the right hand side of the screen the statistics for the selected signal are displayed These statistics show the min max average and current value for the signal that is currently displayed For more information on configuring plots refer to Signal Selection Automatic Re scaling or Manual Re scaling 4a VT Plus for Windows Bommunmca Figure 8 4 Single plot screen VT PLUS Operator s Manual 8 9 Loop Plots Screen This screen shows plots of Flow vs Volume and Volume vs Airway Pressure These plots can be independently re scaled either automatically or manually Controls on the right hand side of the screen can be used to control the appearance of the loop plots Clear Volume Allows you to zero the volume when the breath detect has been turned off Clear Plots Clears both of the loop plots Clear Both Performs both the Clear Volume and the Clear Plot functions Number of Loops
5. FLLIKE Biomedical Gas Flow Analyzer O Operator s Manual FLUKE Biomedical VT PLUS Gas Flow Analyzer Operator s Manual November 2003 Revision C Printed in the USA Part Number 94960 Copyright 2003 Preface Notices Fluke Biomedical Corporation 5200 Convair Drive Carson City NV 89706 USA Customer Service amp Sales 800 648 7952 toll free in the U S Outside USA 775 883 3400 Sales Fax 775 883 9541 Service Fax 775 886 6320 E mail techservices flukebiomedical com Internet http www flukebiomedical com Restrictions and Liabilities Information in this document is subject to change and does not represent a commitment by Fluke Biomedical Corporation Changes made to the information in this document will be incorporated in new editions of the publication No responsibility is assumed by Fluke Biomedical Corporation for the use or reliability of software or equipment that is not supplied by Fluke Biomedical Corporation or its affiliated dealers VT PLUS Operator s Manual iii Revision Record Revision Date Change C 11 03 Added HFOV and RT 200 emulation mode descriptions changed Bio Tek references to Fluke Biomedical Corporation All Rights Reserved Copyright O 2003 Fluke Biomedical Corporation No part of this publication may be reproduced transmitted transcribed stored in a retrieval system or translated into any language without the written permission of Fluke Biomedical Corpo
6. The maximum of the absolute value of the Flow Rate measured during the Expiratory Time The Expiratory Tidal Volume divided by the difference of the Inspiratory Hold Pressure and PEEP Overview 4 About This Manual This manual provides a complete description of the VT PLUS Gas Flow Analyzer and its applications The manual contains information for beginners as well as experts in mechanical ventilator evaluation The quickest way to become familiar with the instrument is to turn it on connect it to a ventilator and test lung and experiment using this manual as a guide The manual is organized as follows Chapter 1 Overview An introduction to the VT PLUS and optional accessories Chapter 2 Installation How to set up the VT PLUS Chapter 3 Keypad Functions A description of VT PLUS keypad functions Chapter 4 System Setup An explanation of the VT PLUS settings and how to adjust them Chapter 5 Display Screens An explanation of the various screens on the VT PLUS and how to access them Chapter 6 Special Functions A description of leak testing and parameters trending functions Chapter 7 Safety Error Messages Troubleshooting and Support Chapter 8 VT Plus PC Software Appendix A VT PLUS Specifications Appendix B Otis Control VT PLUS Operator s Manual 1 9 Overview Installation Chapter 2 1 Unpacking and Inspection 2 Connecting the VT PLUS 3 Attaching the Printer Cable 1 Unpacking and Inspec
7. 4 Annotation 5 End of file 6 Automatic event Each event is marked in the vtp data file with a time stamp For the beginning of a recording and for an annotated event a dialog box will appear with a space provided for the user to enter the text annotation The user initiates TIME STAMP and ANNOTATE events by pressing a button that is provided for each Each event is described below A file control interface is provided to aid in data collection and data playback Automatic events are placed in the file to assist in the rewind and forward functions of the data file playback VT Plus for Windows Opening and Closing Data Files The file menu has two options for opening data files 1 SAVE DATA FILE opens data for recording 2 You may also use the save to file button on the toolbar The file may either be a new or an existing file If it is an existing file you will be prompted to decide if you want to overwrite the existing file If you select NO the file will be appended to at its end 31 Communications Plots E Save DataFile Cus C Review Data File Ctrl O O Close Files Ctrl C File Controls Timed Breaks Generate Signal File Generate Param File Load Flash Print Exit Ctrl Figure 8 10 File menu The REVIEW DATA FILE is available to open an existing file for playback You may also use the open file button on the tool bar To close data files select CLOSE FILES from the menu or use the fil
8. Communications menu to change communications settings Selecting the Serial Communications Mode The VT PLUS has four modes for data transmission via the serial port These are available from the Communications menu The currently selected mode shows a check mark next to its name Test Parameter Wave Form Both Parameters None VT PLUS Operator s Manual This is the parameter that was chosen for running this test This value will not change during the test Starts the continuous transmission of waveform data from the VT PLUS Flow volume airway pressure auxiliary pressure and differential pressure data are received at a 50 Hz rate Starts the automatic transmission of both waveform data and parameter data as described above Start the automatic transmission of parameters that are calculated at the end of a breath These parameters are calculated on a breath to breath basis Please note that no parameters are calculated for a breath if a zero occurs during that breath Selects no data transmission This stops all automatic data transmissions from the VT PLUS 8 19 8 20 6 Data and File Handling File Structure Background and Theory of Operation VT Plus for Windows files handle three kinds of data Signals Parameters and Events Signals are the raw flow pressure and volume time series waveforms Parameters are the breath by breath ventilator parameters calculated by the VT PLUS device Events a
9. Re scale D4 Note Clear Press the soft key below UNITS to change the units of measure for the volume screen Possible units of measure for this screen include 1 Liters ml Milliliters CF Cubic Feet Press the soft key below RESCALE to change the scale on the plot of data to a more appropriate window of values RESCALE uses the current Min Max values to determine plot limits Press the soft key below CLEAR to reset the statistics and re start the plot The user can select the breath parameters displayed in this screen Follow the instructions on page 5 5 to select which breath parameters are displayed in this screen D4 Note VT PLUS Operator s Manual The volume signal is integrated from either the high or low flow signals To select which flow signal is used to calculate volume follow these steps 1 Press the FLOW O key 2 Press the soft key below RANGE until the screen corresponding to the desired flow signal high or low is displayed 3 Press the soft key below RANGE until the screen corresponding to the desired flow signal high or low is displayed Oxygen Screen 5 12 OF ATP 106 8 20 g 75 8 DERE 56 6 Statistics Min 28 3 25 H Max 28 9 Bug 28 8 High Flow ee H 41 LPM Base Flow 66 LPM Gas Air Baro Press 635 1 mmHg The oxygen screen is used to display the signal and statistics for the oxygen sensor The VT PLUS measures oxygen in the high flow port If you need
10. 4226 2 ni Last Volume 1391 8 mi Avg Volume 1408 77 mi Hum f Breaths 5 Total Breaths 3 STACK EXIT Total Volume This indicates the total volume of all breaths together Last Volume This indicates the volume of the last breath taken Avg Volume This indicates the average volume of all breaths taken Num of Breaths This indicates the number of breaths taken Total Breaths This indicates the total number of breaths to be taken When the test is complete press the EXIT soft key Press the STACK soft key to start a new stacked volume test When a stacked volume test is started using the START soft key the test will accumulate the requested number of breaths then end if the test is started using the AUTO soft key the test will automatically restart after the requested number of breaths have been accumulated 6 8 Special Functions 4 RT200 Emulation Mode The VT PLUS has a function for emulating the RT200 serial port communications This is used for some ventilator automated test procedures To set the RT200 emulation mode change the Serial Mode in the SETUP SYSTEM screen More Leak Test Trend Test Stacked Volume Test RT2OO Emulation Mode High Frequency Oscillator To access the RT200 Emulation mode follow these steps 1 2 OR VT PLUS Operator s Manual Press the MORE 4 key Use the and v soft keys to highlight RT200 EMULATION MODE Press the soft key below ENT
11. Barometric Pressure Dialog Box VT PLUS Operator s Manual 8 35 8 36 VT Plus for Windows Specifications Appendix A This appendix provides the device specifications for the VT PLUS Gas Flow Analyzer For more information please contact your Fluke Biomedical Service representative Measured Signals General Specifications Performance Specifications Breath Parameter Accuracy Specifications 1 Measured Signals The VT PLUS measures the following High flow Low flow Airway pressure Low pressure Barometric pressure High Pressure Oxygen concentration Soo Sb ona O doy QUOS APO en Calculated breath parameters High Flow The VT PLUS has a high flow 300 LPM bi directional flow measurement Flow measurements can be either static flows no breath variations or ventilator waveforms i e both an expiratory and an inspiratory phase The flow measurement is made using a differential pressure drop across a resistive screen mesh This flow measurement can be used for pediatric adult ventilators or for determining the performance of many types of flow meters Valves are used to switch between the low flow and the high flow measurements depending on the range selected in the display flow screens see Chapter 5 Display Screens Low Flow The VT PLUS has a low flow 25 LPM bi directional flow measurement The flow measurements can be either static no breath variations or ventilator waveforms i e both an expira
12. Print Help PN PN Soft Keys TEST MODES Figure 3 1 VT PLUS Front Panel 3 2 i H El flow Contrast Adjustment This key is used to adjust the screen contrast to match the user s preference Each time the key is pressed the screen becomes lighter When the minimum contrast is reached the screen is set to the maximum contrast and the screen can be made lighter until the preferred setting is achieved Pause Resume This key lets the user pause the plots and numeric data on the screen to allow further examination of the data or for transcription of the data by the user After the screen has been paused a second press of the Pause Resume key will resume the plot Note The VT PLUS stops sampling the transducers while in the Pause mode Print This key will cause the VT PLUS to print the current data to the printer The mode and format of the printout is set using the printer options function selected under the setup menu Help The help key can be pressed in any screen A brief description of the screen and of the options available from that screen is provided when help is pressed Soft Keys There are four keys located directly below the display on the VT PLUS For every display mode there are options unique to that mode that can be selected with the soft keys flow 0 Key This key is used to select the flow mode on the VT PLUS The flow mode displays signal instantaneous numeric value and
13. The VT PLUS setup options allow the user to specify what type of gas is being used Additional choices are available using the USER DEFINE MODE The USER DEFINED gas settings are set using the PC software The gas calculator on the PC software can determine the effective viscosity for a combination of various gases Refer to Chapter 8 VT Plus PC Software for more details on the gas calculator and on setting user defined gas types The VT PLUS calculates the temperature dependent viscosity for the gas type selected except for user defined gases Therefore when a new flowing gas temperature is entered by the user the VT PLUS calculates the new viscosity For air the sensitivity to temperature is about 0 2596 of reading per degrees Celsius The VT PLUS viscosity calculation for the gas settings assumes dry gas is being used Increased water vapor content can slightly affect the flow accuracy At room temperature a flow measurement error of 0 5 of reading can occur if the relative humidity of the flowing gas is 50 lt Note Never apply humidified gases to the VT PLUS flow sensors Condensation on the flow sensors will cause errors in the flow readings until condensation is dried from flow sensors Balance Gas Settings The gas settings allow for gas combinations with oxygen For example the VT PLUS can be set to use Helium balance Oxygen In this mode the VT PLUS uses the oxygen measurement to determine the oxygen concentration and then
14. given for the test an incident is reported Following the test a report may be printed detailing all the incidents that occurred during the test Starting a Trend Test The trend test setup screen allows the user to choose the parameter to run the test on and to choose the percent limit for the test Initially the start button is not enabled You may only start a trend test after receiving a valid value for the breath parameter you have chosen Once the current value holds the value you want to compare against during the test you may click the START button to begin the trend test Running the Trend Test While a test is running you can t change screens again until you click the STOP button that appears at the bottom of the screen During a trend test several values are reported to the user every time a breath occurs Test Parameter This is the parameter that was chosen for running this test This value will not change during the test Current Value This is the current value of the chosen test parameter Every time a breath occurs this is updated and compared against the initial value of the test parameter Starting Value Shows the initial value for the test parameter This value will not change during the test Difference This value is calculated each time a breath occurs If 1t is greater than the limit an incident is reported Limit This is the value entered before starting the test It will not change during the
15. the requirements of EN 61326 1 1998 for Radiated Emissions and Line Conducted Emissions Verification of compliance was conducted to the limits and methods of the following CISPR 16 1 1993 and CISPR 16 2 1996 P4 Immunity The system has been type tested by an independent accredited testing laboratory and found to meet the requirements of EN 61326 1 1998 for Immunity Verification of compliance was conducted to the limits and methods of the following EN 61000 4 2 1991 Electrostatic Discharge EN 61000 4 3 1995 Radiated EM Fields EN 61000 4 4 1995 Electrical Fast Transient Burst EN 61000 4 5 1995 Surge Immunity EN 61000 4 6 1996 Conducted Disturbances EN 61000 4 11 1994 Voltage Dips Short Interruptions and Variations EC Directive 73 23 EEC Low Voltage User Safety The system has been type tested by an independent testing laboratory and found to meet the requirements of EC Directive 73 23 EEC for Low Voltage Verification of compliance was conducted to the limits and methods of the following EN 61010 1 1993 and IEC 1010 1 Safety Requirements for Electrical Equipment for Measurement Control and Laboratory Use Part 1 General requirements including amendments 1 and 2 VT PLUS Operator s Manual ix Warranty This Warranty is limited and applies only to new products except for computer based software which is covered under a separate Warranty Policy manufactured by Fluke Biomedical Corporation Fluke Biome
16. 5 Flow SGreens ii oi Lec De eet CP Bee ex Ore dE 5 6 High Flow Screen 2 2 teme een e te eds 5 6 Low Flow Screens eei Eod bv cede ve ede tt nne 5 7 Pressure Screens cccccccccccccccccccnonononononononononononononnnnonononnnnnononononononnnonnnnonononnnnnnnnnnnnnonnnnnnnns 5 8 High Pressure Screen oti ete ette ral 5 8 Low Pressure Screen e oreet ee da 5 9 Airway Pressure Screen ssssssssssseeeeseeeeneenneenner nennen nnne 5 10 VollMe Screen e TI TID 5 11 OW PA TOREPE REE E AO T T a 5 11 Oxygen SCION AN 5 12 Full Breath Parameters Test Sore8enN ccccccccccccccncncncnononononononononononcncnononononononononononononos 5 13 Monitor Creeis ein eot ge veia av euam M at ten e ML LU AIE 5 14 UnitS OF Measure oie o eco eo ret a er Det voee ve Caesa ctv diodo ED REF ae 5 15 Chapter 6 Special Functions TriendTestia M x aaa EM DM 6 1 teak TEST COTTON 6 5 Stacked ROT eE E EAEE AEAEE AAE AAA TAE 6 8 RTZOO Emulation Mode i a a a aada a a 6 9 ASS E e uoto A o AEA A E I A 6 12 High Frequency Oscillator Mode sse 6 14 Preface Chapter 7 Safety Error Messages Troubleshooting and Support Electrical Safety and System Maintenance ssesssseeeeeeeenene 7 1 Replacing the Oxygen Sensor sessssssssseseeeeeeeeneennnene nennen rennen ns 7 2 Procedure for Calibrating the OxyYEN oooonocccnoccconcccnonncnonncnnnnonnncn ronca nnn cc nan nan nennen 7 2 Repl
17. E E Figure 8 2 Toolbar menu The toolbar is provided for both convenience and speed It provides a quick and easy way to call often used functions A description of the buttons and their functions follows Li gt Lf al lle Save to file button This button calls up the SAVE AS dialog and allows you to begin saving your data to a file If a file is already open this button is disabled Open file button This button calls the open file dialog that allows you to begin reviewing a file If a file is already open this button is disabled Close file button This button closes any open data files If no file is open this button is disabled File controls button This button calls up the file controls dialog For more information see the Data and File Handling section Print button This button gives you quick access to the print functions Click this and the printer dialog appears Zeroing button This button forces the VT PLUS unit to zero immediately For more information see the Zeroing section Clear Statistic button This button forces the VT PLUS to clear a selected statistic or all of them Re scale button This button forces all the plots to automatically re scale immediately rather than wait for the auto scale to re scale them For more information see the Re scale Plots section Breath Detect Mode button This button allows selection of a given type of breath detection mode such as bi direc
18. MAP PEF PIF PIP IPP jjj j is the is the mean airway pressure MAP in cmH20 kkk k is the peak inspiratory pressure PIP in cmH20 111 1 is the inspiratory pause pressure IPP in cmH20 mmm m is the positive end expiratory pressure PEEP in cmH20 nnn nn is the base flow in LPM 000 0 is the oxygen concentration in 02 ppp p is the barometric pressure in mmHg qqqqqq is the EE ratio rr r is the minimum airway pressure in cmH20 ss s is the assist pressure in cmH2O Xxx x lt CR gt lt LF gt XXX X result returned is in ml X XXX CR LF X XXX result returned is in LPM 1 x xx lt CR gt lt LF gt exp time gt insp time x xx 1 lt CR gt lt LF gt exp time lt insp time x xx ratio of times colon separator XX XX CR LF XX xx returned result in seconds XX XX CR LF XX Xx returned result in seconds XX XX CR LF XX Xx returned result in seconds XX XX CR LF XX xx returned result in seconds Xxx x lt CR gt lt LF gt Xxx x returned result in cm H20 Xxx x lt CR gt lt LF gt Xxx x returned result in L min XXX XX CR LF Xxx xx returned result in L min Xxx x lt CR gt lt LF gt XXX X result returned in BPM breaths per min Xxx x lt CR gt lt LF gt Xxx x returned result in cmH20 Xxx x lt CR gt lt LF gt Xxx x returned result in cmH20 B 7 Transmit String Command Description Response String Name Positive End expiratory p
19. Press Units mmHg Barometric Press 639 6 Breath Detect BiDirection LF BD Threshold 0 50 cen HF BD Threshold 2 00 ru Bi Dir Tidal Vol Expiratory ero Mode Auto The soft keys are used as follows BACK Return to the previous menu A Move up one menu item v Move down one menu item ENTER Modify the highlighted item Settings can be changed to pre selected options or to numeric values For example if you select CORRECTION MODE then press MODIFY it will display the next option such as ATP STPD etc On the other hand when a numeric entry such as B D THRESHOLD is selected and MODIFY pressed it will clear the data entry and accept numeric input from the keypad until the ENTER key is pressed again Following is a detailed description of each of the settings D4 Note Whatever option is displayed when the settings screen is exited will be saved and used for future measurements Gas Settings This setting tells the VT PLUS what type of gas is flowing through the high and low flow ports The VT PLUS uses this information to improve the accuracy of the flow calculations Failure to enter the correct value will cause the flow and volume calculations to be in error System Setup To modify GAS SETTINGS follow these steps 1 Enter the SETTINGS screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled GAS SETTINGS on the screen 3 Press the MODIFY soft key Gas Settings STPD G
20. RANGE to change between low pressure airway pressure and high pressure screens Press the soft key below UNITS to change the units of measure for the airway pressure screen Possible units of measure for this screen include mbar millibar 001 BAR bar 14 7 PSIG Barometric mmHg millimeters of mercury inHg inches of mercury cmH O centimeters of water inH O inches of water PSIG pounds per square inch atm atmospheres kPa kilopascals Press the soft key below RESCALE to change the scale on the plot of data to a more appropriate window of values RESCALE uses the current Min Max values to determine plot limits Press the soft key below CLEAR to reset the statistics and re start the plot The user can select the breath parameters displayed in this screen Follow the instructions on page 5 5 to select which breath parameters are displayed in this screen Display Screens 5 Volume Screen Volume 3 Ba z 25 si co LEM ston 1 SH A AR A RT Statistics Mint 8 342 B T50 OR aca a a TE A TTE nica eC mT A Mane a Ad Avg B Bee a eaa Minute Vol 45 836 L Tidal Vol z9TS5 6 nl The volume screen is used to display the signal and statistics for the volume signal The volume signal is the integral of the flow signal measured in either the high or low flow ports The flow port that is integrated is selected by selecting the high or low flow range from within the flow screen Flow Zero Units
21. Special Functions for a more detailed description of the trend function Clear Press the soft key below CLEAR to reset the statistics and re start the plot When an asterisk appears for a parameter value the parameter is either invalid for the current breath detect mode or the system does not have sufficient information to accurately calculate the parameter For example base flow is invalid during bi directional breath detection mode since the base flow is only seen in the inspiratory and expiratory limbs of the ventilator circuit In another example it would be impossible to measure the inspiratory hold pressure during the expiratory only mode D4X Note The Assist Pressure Assist and the Minimum Pressure Min Pres are not available for trending and cannot be added to other screens using the parameter selection Refer to Chapter 6 for instructions on Assist Mode testing VT PLUS Operator s Manual 5 13 8 Monitor Screen Monitor High Press B 123 mmHg 258 3 ma Yol ume H Bad The monitor screen shows three signals and their corresponding values Alternatively the lower signal can be replaced by a set of four breath parameters The user can select which signals are displayed on the monitor screen Select Assign Units Re scale 5 14 Press the soft key below SELECT to change the position of the plot that can be altered using the ASSIGN and UNITS keys The vertical cursor bar on the rig
22. The VT PLUS displays hours minutes and seconds on the display However the user can set only hours and minutes The time is entered in the HHMM format where HH is the hours in 25 hour format 0 to 23 and MM is the minutes a number between 0 and 59 System Setup To set the time follow these steps 1 Enter the system screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled TIME 3 Press the MODIFY soft key 4 Usethe numeric keys to enter the time in this format HHMM as described above 5 Press the ENTER soft key to exit back to the menu options or the ESCAPE soft key to cancel the change and exit to menu options DX Note For hour and minute values less than 10 a leading zero must be entered For example if the time if 9 05 the user must enter 0905 Date The VT PLUS displays the date with the following information MM is the number between 1 and 12 corresponding to the month DD is the number between 1 and 31 corresponding to the day of the month YYYY is the year To enter the date follow these steps Enter the system screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled DATE 3 Press the MODIFY soft key 4 Usethe numeric keys to enter the date in the format chosen as described in DATE FORMAT 5 Press the ENTER soft key to exit back to the menu options or the ESCAPE soft key to cancel the change and exit to menu options D4 Note Fo
23. This will null offset errors in the pressure transducers During an auto zero the VT PLUS will use pneumatic valves to temporally switch flow ports for the zero Do not use this option if there 1s flow in both flow ports A zero can be forced by manually zeroing a signal even if automatic zeroing is turned on 8 30 VT Plus for Windows 11 Other Setup Functions The VT Plus for Windows software lets you choose the settings in the SETUP menu Breath Detect The VT PLUS has a built in breath detection algorithm The algorithm determines the breath phase i e inspiration expiration inspiratory pause single phase bi directional etc This algorithm is designed to reject signal noise and other artifact when determining the phases of a breath To change the breath detect mode select BREATH DETECT from the SETUP menu and click the preferred option Breath Detect Threshold The VT PLUS breath detection algorithm uses a flow rate threshold that the flow must cross to trigger a change in the breath phase Higher flow rate thresholds yield less sensitive breath detection Lower thresholds yield more sensitive breath detection To enter a new threshold select THRESHOLD from the BREATH DETECT menu under the SETUP menu The following dialog box will appear and you can enter your new value Breath Detect Threshold X Enter a new value for the breath detect threshold 0 00 lpm Y ox i 2 Hep C detours Figure 8 20 Breath T
24. Two tapered 15 mm OD x 22 mm OD tubing adapters P N 48474 Two tapered 15 mm OD x 15 mm OD tubing adapters P N 48475 Two tapered 15 mm ID x 15 mm ID tubing adapters P N 48476 Uu Y U U Y Uy uy Two narrow bore tubing adapters P N 48477 Two flexible 15 mm ID x 22 mm ID tubing adapters P N 48471 Two 1 4 NPT male to 1 8 ID tubing barb fitting Nylon P N 48480 Two luer to barb fittings P N 48478 Two replacement fuses 0 5 A slow blow P N 46026 Uu y U Uy One DISS Handtight Nut Nipple to 1 4 ID hose barb adapter P N 49342 e Certificate of Calibration Data Sheet Connecting the VT PLUS Pneumatic Connections The VT PLUS can be connected to a ventilator and a test load in either a bi directional or uni directional flow configuration The following is a description of various connections on the VT PLUS High Flow inlet and exhaust The outer diameter of the high flow ports is a standard 22 mm fitting to allow connection using patient hoses The inner diameter of the high flow ports is designed to accept 15 mm male respiratory fitting such as endotracheal tubes gas sampling adapters etc A A Pressure inside the high flow port should not exceed 120 cmH5O Only dry gasses should be measured using the high flow port Do not use this port to measure exhaled or artificially humidified gasses Low Flow inlet and exhaust The outer diameter of the low flow ports is a standard 15 mm to allow connection with standard respirat
25. a serial cable into the RS232 port on the back of the VT PLUS and into an unused serial com port on your PC When the VT Plus PC software is launched the VT PLUS is automatically placed into the computer control mode No graphics are available on the VT PLUS screen while serial communications are active A screen will be displayed on the VT PLUS indicating that serial communications are enabled Installing the Software Insert the VT Plus for Windows O disk into a 3 25 disk drive on your PC Select RUN from the start menu under Microsoft Windows 95 98 NT When the run dialog box shows type in a setup exe if your disk drive is not a substitute its drive letter for a Click OK The installation program for VT Plus for Windows asks you several questions before installing the program You are given the option to specify where you want the program installed on your computer If you are installing over a previous version of this software you will be asked where to back up old copies of your files Also you are asked where to put the icons for the VT Plus for Windows program Simply follow the instructions given by the installation program If no changes are made to the default installation options VT Plus for Windows will be installed to C Program Files VTPlus and the shortcuts to the program will be in the VT Plus group Starting the Software With the software installed and the VT PLUS connected you are
26. all the ventilator parameters The minimum pressure and the assist pressure are displayed on the lower left column VT PLUS Operator s Manual 6 13 6 14 6 High Frequency Oscillator Mode The VT PLUS with firmware version 1 08 04 and higher has a function for testing high frequency flow and airway pressure To access the high frequency oscillator function follow these steps 1 Press the MORE 4 key 2 Use the and v soft keys to highlight HIGH FREQUENCY OSCILLATOR 3 Press the soft key below ENTER The high frequency oscillator mode samples flow and airway pressure at a much faster rate 5x than the VT PLUS does in normal operation It is useful for monitoring the function of extremely high frequency breath rates up to 800 bpm In HFO mode the VT PLUS collects two seconds worth of data at a time After the data is collected it is processed to calculate parameters and the first half second of data is plotted on the display The mean min and max values are calculated for both the pressure and flow signals Please note that these values apply to the whole two seconds of data not just the half second that is plotted The breath rate is calculated and displayed in both breaths per minute and Hz The inspiratory time and tidal volume are also calculated High Freq Test CcomH20 Press Flow LPM enr teh peut Max 2 18 1 58 B Ba i 58 3 00 To run the HFO test once press the START soft
27. appropriate communication port You can tell that communications are established when the software displays waveforms and the displayed values for flow and pressure are changing 2 Overview of VT Plus for Windows O Software Purpose and Intended Use VT Plus for Windows provides a simple interface for recording and playing back data calculated by the VT PLUS Most functions on the VT PLUS are available using VT Plus for Windows Using VT Plus for Windows VT Plus for Windows provides a simple interface for recording and playing back data calculated by the VT PLUS Most functions on the VT PLUS are available using VT Plus for Windows The VT Plus for Windows software has several review screen and test screens that are accessed through the tab set near the bottom of the screen 5 These screens are Monitor screen Single Plot screen Loop Plots screen Full Test screen Trend Test screen Leak Test screen and the Stacked Volume Test screen Other functions can be accessed through the menu 1 Commonly used menu functions have been assigned to a button on the tool bar 2 The very bottom of the screen has a status bar 6 that shows the current status of several user settings including zeroing mode correction mode and the selected flow port System messages such as ZEROING will also appear here VT PLUS Operator s Manual 8 3 8 4 e T Plus for Windows Airway Pressure 10 Menu Tool Bar Statistic
28. assumes the balance of the gas concentration is helium The VT PLUS calculates the effective viscosity for the combination gas at the specified temperature The oxygen concentration used in the gas setting for the balance gases is automatically updated every second Db Note For air oxygen mixtures use the nitrogen balance oxygen N2 bal O2 gas setting The flowing gas is assumed to be dry and therefore the relative humidity used in the viscosity calculation is assumed to be zero percent BTPS and STPD Corrections The VT PLUS corrects all flow measurements to conditions of ambient temperature and pressure without adjusting for the volume of water vapor The ambient pressure is obtained from the measured barometric pressure The user sets the ambient temperature by using the setup menu It should be noted that the relative humidity setting on the VT PLUS is only used for the BTPS and STPD correction VT PLUS Operator s Manual 1 5 BTPS stands for Body Temperature and Pressure Saturated with water vapor In this compensation mode the flow rate and therefore volumes are corrected such that the reported flow is equal to the flow if the gas temperature and pressure was changed to body conditions 37 C and ambient pressure Further the flow is compensated to add the amount of water vapor as if to make the gas fully saturated i e 100 relative humidity In this correction the relative humidity setting is used to determine the amount of
29. calculate the viscosity and molecular weight of a gas mixture One gas serves as a balance gas This means that the percentage of this gas is automatically adjusted to insure that the total percentage of gases totals 100 To change which gas is the balance gas click the radio button to the left of the gas s name Any of the five standard gases may be used as a balance gas You can adjust of what percentage each gas makes up of your mixture by changing the values in the two columns to the right of the gas s name If you have a gas in your mixture that is not one of the standard five you may use one of the user gases The user gases have three predefined gas options and a user defined option Select your gas from the list of predefined gases or if the gas you are using isn t one of these predefined gases select the user defined option Enter the molecular weight viscosity coefficient and viscosity intercept into the boxes given Clicking the AIR button or the RESPIRATION button will set the calculator to the defaults for air or respiration Enter the temperature and relative humidity for both inspired and expiratory gases in the boxes provided Viscosity and molecular weight are calculated every time you make a change to any of the controls When you are done click the OK button to accept these values The viscosity relative humidity molecular weight and temperature will be put into the appropriate boxes on the GAS SETTINGS dialog box
30. ccccccccccnncncnnncncccnonononnnnnononononennnnnononnnnnnnnnnnnnonnnnnrnnnnnanenannnnnns 1 5 Breath DetectiON ccccccccoonnnccnnncnoconononenenonononononennnnnnnonnnnnnnnnnnnnonnnnrrnnnnnanonanonenos 1 7 Galculated Parameters chai cree ta 1 8 Abo t This Manllal isis ir certet eiecti eco par EP ER Era nde Ve ERR e E SOR RI 1 9 Chapter 2 Installation Unpacking and Inspection cion cet bigest dienes 2 1 Gonnecting the VT PLUS iet eed iR Rete d e re dei Se beret LEER edie 2 2 Pneumatic Connections eese nennen nnne enne 2 2 Quick Installation Operations Guide esseeenenen 2 3 Bi Directional Flow Mode oooococoonocconnoncccconacccnnononccnnnnocc cnn acne nn nnne niente nennen 2 3 Uni Directional Flow Mode seem eene 2 4 lnspiratory Testing eiie e e de 2 4 Expiratory Testing eter o os 2 4 Attaching the Printer Cable ooooconcoconnccconcconccnnonccnonnnnoncnnnncoroncnnnn carr cnnnn narran anar nc nnnn cane 2 6 Chapter 3 Keypad Functions VIRPLUS Keypad EUnctlons oio et dee nemen es 3 1 VT PLUS Operator s Manual Xii Chapter 4 System Setup Using the Setup Scr eenin cciei eaten er e a in Deb E ee Ree alee 4 1 Settingsz AEE T PRM AN UI TA EA ERE ERA 4 2 Gas Settings iria nis rae a eene aera ev 4 2 Gas Temperature 5 tate e Ere gie re alent date edes 4 4 Ambient Temperature oooococonnoccnnnocccnnonncncnnnncncnnnnne nera ener nennt rne n
31. cmH20 xx x lt CR gt lt LF gt Xx x returned result in cmH20 s Xx x lt CR gt lt LF gt xx x returned result in cmH20 s Upon initiating this command and each time a incident is detected return the following string aaaaalbbbbblcccldddddddddd lt CR gt lt LF gt aaaaa current value bbbbb starting value ccc difference dddddddddd time aaaaaalbbbbbleccccidddleeelffflgggl hhhhhhhhhh lt CR gt lt LF gt aaaaaa Test Parameter bbbbb Current Value ccccc Starting Value ddd Difference eee Limit fff of Tests ggg of Incidents hhhhhhhhhh Elasped Time XXX X CR Xxx x returned result in Cm H20 XXX X CR Xxx x returned result in Cm H20 OTIS Control Fluke Biomedical Corporation 5200 Convair Drive Carson City NV 89706 USA 800 648 7952 775 883 3400 FAX 775 883 9541
32. cmHz The high pressure screen is used to display the signal and statistics for the pressure signal from the high pressure ports of the VT PLUS Range Units Re scale D4 Note Clear Press the soft key below RANGE to change between low pressure airway pressure and high pressure screens Press the soft key below UNITS to change the units of measure for the high pressure screen Possible units of measure for this screen include mbar millibar 001 Bar bar 14 7 PSIG Barometric mmHg millimeters of mercury inHg inches of mercury cmH 0 centimeters of water inH O inches of water PSIG pounds per square inch atm atmospheres kPa kilopascals Press the soft key below RESCALE to change the scale on the plot of data to a more appropriate window of values RESCALE uses the current Min Max values to determine plot limits Press the soft key below CLEAR to reset the statistics and re start the plot The user can select the breath parameters displayed in this screen Follow the instructions on page 5 5 to select which breath parameters are displayed in this screen Display Screens Low Pressure Screen Lou Press 168 a SA 5 T eH A c P MS HEELS 4 8 Statistics Mint B 4 56 B Max 6 4 Ava B B 188 E PIP 2 7 cmHz IPP z 3 cmHz MAF B 2 cmHz PEEP B A cmH20 The low pressure screen is used to display the signal and statistics for the pressure signal from the low pressure
33. detection mode when the VT PLUS is analyzing only inspired breaths or when the VT PLUS is connected in the inspired limb of the ventilator breathing circuit Uni directional expired only Use this breath detection mode when the VT PLUS is analyzing only expired breaths or when the VT PLUS is connected in the expired limb of the ventilator breathing circuit Off Use this mode to measure continuous flow and volume without attempting to detect breaths Use this mode to integrate a flow over a long period of time To select the breath detection mode follow these steps Enter the settings screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled BREATH DETECT 3 Press the MODIFY soft key until the desired option is displayed 4 Press the BACK soft key to exit back to the setup menu options Breath Detect Threshold The VT PLUS breath detection algorithm uses a flow rate threshold that the flow must cross to trigger a change in the breath phase Higher flow rate thresholds yield less sensitive breath detection Lower thresholds yield more sensitive breath detection System Setup To enter the breath detect threshold follow these steps Enter the settings screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled LF BD THRESHOLD to adjust the low flow threshold or HF BD THRESHOLD to adjust the high flow threshold 3 Press the soft key below MODIFY Use the numeric keys
34. difference between min and max airway pressure is less than 5 0 cmH O while in expiratory only breath detect mode CORRECTIVE ACTION Ensure that a load Test Lung is installed in the ventilator circuit and that the circuit is not open to air i e an unconnected hose Decrease lung compliance so that the change in airway pressure is greater than 5 cmH O during the breath A better solution use the bi directional breath detect mode Occurs when the VT PLUS can not keep up with the data input The V7 PLUS can buffer a few seconds of data when it is busy changing screens and such CORRECTIVE ACTION If the error message appears several times during normal monitoring i e no keys are being pushed call factory for service Occurs when a flow zero isn t complete after 150 attempts CORRECTIVE ACTION Attempt to zero again Ensure that no flow or pressure is on either the high or low flow ports If message does not go away after several attempts with no flow or pressure applied call service Occurs when more than 1000 characters are waiting to be sent CORRECTIVE ACTION RS232 serial communications is probably awaiting hardware handshaking If using a terminal program ensure the hardware handshaking is enabled Ensure that the RS232 cable is the cable supplied with the VT PLUS Occurs when users try to print with no printer selected CORRECTIVE ACTION Select a printer using the setup menu 7 5 Printer Not Selecte
35. may be desirable to turn off automatic zeroing for a short while during a critical test To turn automatic zeroing on or off follow these steps Enter the settings screen from the setup menu Use the and or v soft key to highlight the line labeled ZERO MODE Press the MODIFY soft key until the desired option is displayed Su Press the BACK soft key to exit back to the setup menu options VT PLUS Operator s Manual 4 7 System Selecting the soft key for SYSTEM causes the VT PLUS to display the system selection Screen System Time 15 53 11 Date 05 03 2001 Date Format HH DD TY Y Y Demo Data Off Filtering Hone Display Cal Date Yes Serial Mode Hone Printer Options Audio Levels Restore Defaults The soft keys are used as follows BACK Return to the previous menu Move up one menu item v Move down one menu item MODIFY Modify the highlighted item Settings can be changed to pre selected options or to numeric values For example if you select FILTERING then press MODIFY it will display the next option such as LOW OFF etc On the other hand when a numeric entry such as TIME is selected and MODIFY is pressed it will clear the data entry and accept numeric input from the keypad until the ENTER key is pressed Following is a detailed description of each of the settings D4 Note Whatever option is displayed when the systems screen is exited will be saved and used for future measurements Time
36. of the flow signal over a period of time Pressure Measurements The VT PLUS provides several pressure measurement capabilities There are two external pressure measurements available to the user There are also three more internal pressure measurements External Pressure Measurements These have been called Low Pressure and High Pressure The low pressure measurement has a range of 500 mmHg about 10 psi The high pressure measurement has a range of 100 psi about 5200 mmHg Both the high and low pressures are differential measurements As such the measured pressure is the pressure difference between the positive and negative ports If only one of the pressure connections is made the measurement is equivalent to a gauge measurement For gauge pressures the measurement is relative to the ambient pressure This is how a normal pressure gauge works If a positive gauge pressure is applied to the measurement port a positive pressure reading will result If a negative gauge pressure is applied to the measurement port a negative pressure reading will result Likewise if a positive gauge pressure is applied to the measurement port a negative pressure reading will result If a negative gauge pressure is applied to the measurement port a positive pressure reading will result Fluidic Pressure Measurements The connection for both the high and low pressure are labeled as compatible with either fluids or gasses
37. of the individual signals select its name from the ZERO menu Airway pressure and flow are always zeroed at the same time VT PLUS Operator s Manual 8 5 Setup The setup menu provides access to most of the user setup features found in the VT PLUS including Flow Port Use this menu to select which flow port you want to use The checked option is the currently selected flow port Zeroing The zeroing menu is used to select a zeroing mode either automatic or manual The current zeroing mode is checked See the Zeroing section later in this chapter Breath Detect Use the breath detect menu to switch breath detection modes and to set the breath detect threshold for the current flow port Gas Settings The gas settings function brings up the GAS SETTINGS dialog box See the Gas Settings section later in this chapter Barometric Pressure This function brings up the barometric pressure dialog box Enter the local barometric pressure in mmHg and click OK to calibrate the barometric pressure sensor Signal Units The signal units function brings up a dialog box for entering the desired units for the signals See Signal Selection under the Plots section of this chapter Print Header The print header function sets the print header in the VT PLUS See the Printing section in this chapter Help The help menu accesses the VT Plus for Windows O help file VT Plus for Windows Toolbar Description Accom E
38. re scale to occur immediately VT PLUS Operator s Manual 8 27 Manually Re scaling Plots If you want to specify a specific range to view on a plot you can do this easily in one of two ways 1 Select SCALING and MANUAL SCALE from the plot s menu bar Then click on the preferred plot Scaling Manual Scale Figure 8 16 Scaling Manual Scale The following dialog box will appear and you can set the range for re scaling as preferred New Scale Range Figure 8 17 Manual Scale New Scale Range 1 You can right click on the plot that you want to re scale Select MANUAL SCALE and the above dialog box will appear You can then select the preferred range 8 28 VT Plus for Windows Signal Selection The three plots on the monitor screen and the plot on the single plot screen can be set up to display any of the signals flow volume airway pressure low pressure high pressure or oxygen To change the signal that is displayed on a plot select the plot s name from the plots menu and select the name of the signal you want displayed The desired signal s name should appear on the title of the plot and above the statistics to the right of the plot The statistics and the plot now reflect the new signal and are displayed in the selected units for that signal Statistics Zero Setup Help Scaling d E Monitor Plot 1 Monitor Plot2 Wolume Monitor Plot3 Airway Pressure Single Plot id Low Pressure
39. ready to start the software application The first time the software is used the application will attempt to establish communications with the VT PLUS The following will be shown on the screen FLUKE Biomedical VT Plus Gas How Analyzer Designed by KOAR Medical Technologies The software will check the serial communication ports also called Comm Ports listed in the Windows Registry If the software cannot find the VT PLUS the following screen will appear allowing you to set which communication port the VT PLUS is connected to Once the software has established communication with the VT PLUS an initialization file is created that is read by the software during future use The software uses the information in the initialization file to know where to check for the VT PLUS VT Plus for Windows An error can occur if the communication port is in use by another device and or software application If the communication port is already open the following error will be shown VT Plus for Windows e ie pen device already open To solve this error simply close the application that is using the desired communication port It should be noted that opening the VT Plus for Windows multiple times would also cause the same error message Finally if the communication port for the VT PLUS needs to be manually set or changed start VT Plus for Windows amp and select COMMUNICATIONS COMM PORT from the pull down menu Select the
40. screen follow these steps 1 Goto the screen for which the parameters will be selected For example if you wish to select parameters for the flow screen press the FLOW O button so that the flow screen is viewed 2 Press the PARAMETERS 9 key A screen listing all of the possible parameters will be shown A small box is drawn to the side of each parameter name An X in the box adjacent to a parameter name indicates that the parameter is selected 3 Use the soft keys labeled and v to highlight the parameter you wish to remove only four parameters can be viewed for each screen An existing parameter must be removed before a new parameter can be added Press the soft key labeled ENTER to remove the parameter The X in the box adjacent to that parameter will be removed indicating the parameter has been deselected 4 Use the soft keys labeled and v to highlight the parameter you wish to add Press the soft key labeled ENTER to add the parameter An X will be added to the box adjacent to that parameter 5 Repeat steps 3 and 4 above for each additional parameter you wish to change 6 Use the soft key labeled EXIT to return to the previous screen gt Note Parameter selections will be retained even when the VT PLUS has been turned off or when power has been disconnected Selecting the option labeled set all screens to the same parameters in the parameters screen will show parameters currently selected for all scree
41. screen has space to display 4 of the breath parameters Using the parameters function the four breath parameters can be selected Note that if 4 parameters are already selected then no more can be selected until one of the previously selected parameters is cleared Also note that the parameters that are selected only apply to the screen that the VT PLUS was in when the parameters key was pressed This key is also the 9 key for numeric data entry Keypad Functions System Setup Chapter 4 Using the Setup Screen Settings System Utilities Information 1 Using the Setup Screen To enter the system setup screen press the key labeled SETUP and the following screen is displayed Setup System Utilities Information Use the and v soft keys to select which options to adjust Press the soft key labeled ENTER to select the menu item Settings screen contains a menu for choosing options that affect flow and measurement on the VT PLUS System screen contains a menu for choosing options that affect how information on the VT PLUS is set up such as time and date Utility screen is used for system service and calibration only Information screen contains product information about the VT PLUS such as serial number and copyright 2 Settings Selecting the soft key for SETTINGS causes the VT PLUS to display the settings selection screen Settings Gas Settings Correction Mode ATP Baro
42. statistical data for the high or low flow signal This key is also the 0 key for numeric data entry Keypad Functions pressure 1 Key zn This key is used to select the pressure mode p reSSUrE The pressure mode displays the signal instantaneous numeric value and statistical data for the high low or airway pressure signal This key is also the 1 key for numeric data entry volume 2 Key A This key 1s used to select the volume mode y olume The volume mode displays the signal instantaneous numeric value and statistical data for the volume signal This key is also the 2 key for numeric data entry O4 3 Key This key is used to select the oxygen mode The oxygen mode displays the signal instantaneous numeric value and statistical data for the oxygen signal This key is also the 3 key for numeric data entry more 4 Key This key is used to select other tests such as the Leak test and the Trend test This key is also the 4 key for numeric data entry full 5 Key This key is used to select the full breath parameters mode The full mode displays all of the breath parameters calculated by the VT PLUS following every breath Note that one of the breath detect settings must be enabled to observe volume signals or data Refer to Chapter 4 System Setup for breath detection settings This key is also the 5 key for numeric data entry VT PLUS Operator s Manual 3 3 3
43. to enter the barometric pressure in LPM 5 Press the soft key below ENTER to exit back to the menu options or the ESCAPE soft key to cancel the change and return to menu options Inspiratory versus Expiratory Tidal Volumes The VT PLUS measures tidal volume when performing ventilator measurements This option allows the user to choose between the expiratory or the inspiratory tidal volume The default setting is inspiratory D4 Note This setting only applies when the bi directional breath detection mode is selected To change between inspiratory and expiratory tidal volume follow these steps Enter the settings screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled BI DIR TIDAL VOL 3 Press the MODIFY soft key until the desired option is displayed 4 Press the BACK soft key to exit back to the setup menu options Zero Mode All of the pressure and differential pressure flow sensors in the VT PLUS need to be periodically zeroed or calibrated to a zero reference This zero function can be set to occur automatically at pre determined intervals or only when the user requests the function by pressing the key labeled ZERO 7 When a zero occurs valves inside the device open the sensors to ambient pressure and measure the zero value that will be subtracted from future measurements Note that no breath parameters will be calculated for any breath in which a Zero occurs For this reason it
44. water vapor that would need to be added STPD stands for Standard Temperature and Pressure Dry In this compensation mode the flow rate and therefore volumes are corrected such that the reported flow is equal to the flow if the gas temperature and pressure was changed to standard conditions 0 C and 760 mmHg Further the flow is compensated to subtract the amount of water vapor as if the gas was dry i e 096 relative humidity In this correction the relative humidity setting is used to determine the amount of water vapor that would need to be subtracted STPD stands for Standard Temperature and Pressure Dry In this compensation mode the flow rate and therefore volumes are corrected such that the reported flow is equal to the flow if the gas temperature and pressure was changed to standard conditions 21 C and 760 mmHg Further the flow is compensated to subtract the amount of water vapor as if the gas was dry i e 0 relative humidity In this correction the relative humidity setting is used to determine the amount of water vapor that would need to be subtracted Flow Zeroing The differential pressure transducer used to measure the flow rate is subject to baseline offset drift This is most pronounced during the VT PLUS warm up period The VT PLUS provides both a manual and an automatic zero function for zeroing the flow In measuring flow the same pressure transducer is used for both the high and low flow ports A se
45. while the airway pressure screen is active The airway pressure is also zeroed automatically when the FLOW zero occurs Note that the flow zero may either be performed manually or in an autozero mode Barometric Pressure Another Special Case The offset drift can be adjusted on the barometric pressure measurement by entering the correct barometric pressure on the SETUP SETTINGS menu This is typically not needed However it provides a means for the user to ensure that the barometric pressure measurement is as accurate as possible Oxygen Measurements The oxygen measurement is performed using a galvanic oxygen cell on the high flow port near the exhaust The VT PLUS interprets the measurement from the oxygen sensor as a partial pressure of the total pressure in the high flow circuit The total pressure is the airway pressure plus the barometric pressure The oxygen percentage is calculated as the fraction of the partial pressure of oxygen relative to the total pressure It should be noted that changes in the total pressure i e airway pressure will result in a change in the partial pressure of the measured oxygen even though the percentage of oxygen is the same Since the pressure can change much faster than the response time of the oxygen sensor a small transient 1 to 2 of full scale error can occur in the oxygen measurement when there is a fast change in the pressure at the oxygen sensor Whenever an oxygen measurement is made or whe
46. with humidified gases Condensation on the flow sensors causes a calibration error on the flow measurement Invalid parameters exist in expiratory only breath Some parameter values are always invalid in this mode due to insufficient information in the expiratory only signal Run DRY air through the flow sensor for 10 to 30 minutes to allow the screen mesh to dry Do not use the VT PLUS with condensing humidified gases Use the bi directional breath detect mode Ensure the VT PLUS is placed between the Y of the breathing circuit and a test lung All parameters are invalid including base flow The VT PLUS must be able to accurately detect base flow for the parameters to be valid Increase the end expiratory period by either changing the E ratio or by decreasing the lung compliance higher pressures Ensure that the change in airway pressure during the breath is greater than 5 cmH O VT PLUS Operator s Manual Tidal volume errors in expiratory only mode Flow or pressure measurement is not equal to zero when zero flow or pressure is applied Some ventilators servo control the base flow during the expiratory period Since the VT PLUS must assume the base flow is constant during expiration errors will result due to the changing base flow from the ventilator during the expiratory phase Baseline drift of pressure transducer Use the bi directional breath
47. 0 to the right of the title bar indicates that automatic sensor zeroing mode has been selected Bi directional breath detection Use this breath detection mode when analyzing both inspired and expired breath data or when the VT PLUS is connected between the load lung simulator and the Y piece in the breathing circuit Uni directional expired only Use this breath detection mode when the VT PLUS is analyzing only expired breaths or when the VT PLUS is connected in the expired limb of the ventilator breathing circuit Uni directional inspired only Use this breath detection mode when the VT PLUS is analyzing only inspired breaths or when the VT PLUS is connected in the inspired limb of the ventilator breathing circuit ATP This indicates the conversion of gas flow and volume to ambient temperature and pressure BTPS This indicates the conversion of gas flow and volume to body temperature of 37 C with 100 relative humidity STPDo This indicates the conversion of gas flow and volume to a standard temperature of 0 C and a standard barometric pressure of 760 mmHg STPD This indicates the conversion of gas flow and volume to a standard temperature of 21 C and a standard barometric pressure of 760 mmHg Inspiratory Tidal Volumes This indicates that the reported tidal volumes are measured over the inspiratory phase of the breath This only applies to the bi directional breath detect mode Expiratory Tidal Volumes This in
48. 0 Hz lt Note Airway pressure is internally tapped off the proximal flow sensor port which is the port closest to the exhaust port on the VT PLUS High Flow Port Maximum Flow Rate absolute value eem e 500 Ipm Operating Flow Range eq cete chance etre o pie Ll 300 Ipm ACCUFACY 23 iein ities eae 2 0 of reading or 0 10 Ipm whichever is greater Resolution iii betes Re ee ee ends ect dee Bae ies 0 01 Ipm Frequency Response gt 25 Hz or t10 00 40 ms whichever is greater Sample Rate io cota lidia eie d n id 100 Hz Dynamic Resistance oooococccccccccnonccccccccncnnnononnnncnncnnannnnnnnnnncnnnanancnnos lt 2 00 cmH20 9 60 Ipm Low flow Dropouts oen eee A ee see 1 0 Ipm Breath Detect Threshold user settable ooooooconnccc nnoccconanancnononcncnnnan non nanononnnarnncnnnos 2 0 lpm Volume Range eei ete ee gt 601 PX Notes e Tidal Volume Accuracy 3 of reading or 10 ml whichever is greater e Volume Accuracy tested to 7 liters e Flow accuracy is specified for dry air or oxygen e Donotuse with humidified gases Low Flow Port Maximum Flow Rate absolute Value oooooonoocccononocinnnoncnononcncnnnornnnnnnrn cnn nor o nn nnnnnnnnnnnnos 50 Ipm Operating Flow Range t em e ERR RIBERA 25 Ipm ACCUIACY pee its 2 0 of reading or 0 04 lpm whichever is greater A eto enin rnd 0 01 Ipm flow gt 1 Ipm 0 001 lpm flow lt 1 Ipm Frequency Response gt 25 Hz or t10 00
49. 20 8 686 L 45 37 53 1 Special Functions 2 Leak Test The VT PLUS has a function for testing the leak rate of a sealed vessel or test lung A leak test can be done using the high pressure low pressure or airway pressure signals Be sure that maximum pressure ratings are not exceeded when performing a leak A test See Appendix A for absolute maximum pressure ratings for each pressure port Exceeding maximum pressures will damage the VT PLUS Access the leak test function by following these steps 1 Press the MORE 4 key 2 Use the and v soft keys to highlight LEAK TEST 3 Press the soft key below ENTER Use the leak test setup screen to select the leak test parameters Leak Test Current Pressure 7 7 Pressure Unit Kpa Compliance 0 0 ml cmH20 Test Time 0 50 00 To select which pressure channel will be used for the leak test press the soft keys below nand v until PRESSURE CHANNEL is highlighted Press the soft key below MODIFY until the desired pressure channel is selected D4 Note When AIRWAY is selected the airway transducer will be connected to the currently selected flow channel Both flow channels can be tested however the appropriate channel must be selected using the RANGE function in the flow mode screen To enter the compliance of the test chamber test lung press the soft keys below and v keys to highlight LUNG COMPLIANCE Press the soft key below MODIFY Press the numeric keys to
50. 4 monitor monitor 6 Key This key is used to select the monitor mode The monitor mode is used to display the signal and instantaneous value for three of the signals measured by the VT PLUS Alternatively the lower of the three plots may be replaced by selected breath parameters The user can select the signals and or parameters that are displayed This key is also the 6 key for numeric data entry zero 7 Key This key initiates the zero function in the VT PLUS All of the pressure and differential pressure flow sensors in the VT PLUS need to be periodically zeroed or calibrated to a zero reference When zero is selected the device measures the zero value of the selected signal for flow measuring The VT PLUS can be set to periodically call the zero function Refer to Chapter 4 System Setup for Zero Mode Descriptions This key is also the 7 key for numeric data entry setup 8 Key This key is used to access the VT PLUS configuration and setup screens When this key is pressed a menu is displayed The soft keys are used to navigate the menu From this menu other sub menus are accessible to adjust the various configuration settings The details of this menu and its sub menus will be described later This key is also the 8 key for numeric data entry parameters 9 Key This key is used to select which of the breath parameters are displayed in the various modes Each mode
51. 40 ms whichever is greater Sample Rate 5 codd decade ad t del dc euh cate 100 Hz Dynamic Resistance eri eet eget a lt 2 5 cmH20 O 5 Ipm Low flow DropOoUutis cie re onec te ater ne ata 0 01 Ipm Breath Detect Threshold user settable s 0 50 Ipm Mol rme Rarnge acus et horret ac cte e ent a edle catu t60l PX Notes e Tidal Volume Accuracy 3 of reading or 2 ml whichever is greater e Volume Accuracy tested to 1 liter e Flow accuracy is specified for dry air or oxygen e Do not use with humidified gases VT PLUS Operator s Manual 4 Breath Parameter Accuracy Specifications lt Note Ifa choice of readings is indicated by an or choose whichever is greater for example 396 or 250 ml whichever is greater Inspiratory and Expiratory Tidal Volume 0 1 ml As specified in As specified in high low flow high low flow spec spec Minute Volume 0 001 Ipm 056011 95 gt A Breath Rate 0 5 150 bpm Inspiratory to Expiratory Time Ratio 0 01 1 200 to 200 1 2 or 1 I E Ratio 5 to 40 cmH O 3 or 0 5 cmH 0 Lung Compliance 0 1 ml cmH 0 0 150 ml cmH50 5 or 5 ml cmH 0 0 01 lpm 0 30 lpm 2 or 0 5 lpm 1 Inspiratory pause time gt 0 5 s De oes Expiratory pause time 0 5 s A 6 Specifications OTIS Control Appendix B Connecting the VT PLUS VT PLUS Serial Mode Communication Parameters Message Structure Command Types 1 Connect
52. CALE Display Screens Low Flow Screen Lou Flau 3 ATP 106 a 0 00 sa 8 LPM B a Statistics Mint 25 1 5HB a Max 34 3 Bg TT i amp 8B 8 Tidal Vol 178 4 ml PEF 26 12 LPM PIF 14 31 LPM Breath Rate 18 bpm The low flow screen is used to display the signal and statistics for the flow in the low flow port of the VT PLUS Range Units Re scale PX Note Clear Press the soft key below RANGE to change from a high flow screen to a low flow screen and back again Press the soft key below UNITS to change the units of measure for the low flow screen Possible units of measure for this screen include LPM Liters per minute CFM Cubic feet per minute LPS Liters per second ml min Milliliters per minute ml sec Milliliters per second Press the soft key below RESCALE to change the scale on the plot of data to a more appropriate window of values RESCALE uses the current Min Max values to determine plot limits Press the soft key below CLEAR to reset the statistics and re start the plot The user can select the breath parameters displayed in this screen Follow the instructions on page 5 5 to select which breath parameters are displayed in this screen VT PLUS Operator s Manual 5 7 5 8 4 Pressure Screens High Pressure Screen High Press 258 123 aca ca unas Co OQ OL a Statistics Min 3 125 Maxi 5 Fg B 258 PIP 5 T emHz0 IPP 2 8 cmHz MAF B 2 cmHz FEEF B 6
53. Connect the ventilator breathing circuit with the VT PLUS in the bi directional measurement configuration Venen Hose Ventilator Lon Outlet Figure 6 2 Ventilator Breathing Circuit setup for Bi directional measurements S Hose Ia 3 Adjust the ventilator controls so that an effort negative pressure at the lung during the expiration hold period of the ventilator s breath cycle will trigger the ventilator D4 Note Use the Synchronized Intermittent Mandatory Ventilation SIMV mode or Intermittent Demand Ventilation IDV mode if the ventilator provides it D4 Note You will need to test the control setting by applying upward force at the back of the test lung and observing if the ventilator triggers as desired Set a low breath rate to allow the distinction to be made between a triggered assist breath and a mandatory breath Special Functions D4 Note You may wish to attach an external motor driven cam system or a pneumatic actuator to the top plate of the test lung to carry out a more repeatable performance study such as to determine work of breathing 4 Allow ventilator to deliver breaths in a steady manner Then gently lift the back of the test lung top plate during the expiratory hold period in a smooth steady pull to create negative pressure Repeat several times using different forces to approximate the minimum patient effort required to trigger the ventilator The full test screen will show
54. ER Press the SETUP key Use the and v soft keys to highlight SYSTEM Press the soft key below ENTER Use the and v soft keys to highlight SERIAL MODE Press the MODIFY soft key until RT200 is displayed Press the BACK soft key to return to setup menu Press the BACK soft key again to exit setup and the RT200 screen will appear 6 9 6 10 RT 200 F1 cise F2 H3 Bu nsa Bi Commands Fdi 3 lit O28 H2 d String Fd4ifx2 C100 M5 Ase 50F1048H In the emulation mode serial RS232 commands can be sent to the VT PLUS in the format of the communication protocol used by the RT200 When a command is received it is displayed in the space labeled RECEIVED STRING The command box displays the active command and the units of the command F41 3 lit O226 N2 If the peak mode is active the command box will display peak at the end of the command string The status of the RT200 special functions are displayed in the boxes 00 01 F1 F2 The meaning of the special functions can vary depending on the active function Please refer to the RT200 Calibration Analyzer Operation Manual from Allied Healthcare Products Inc For the format of the serial commands the user should refer to the document Serial Interface for the RT200 Calibration Analyzer System Operation Manual from Allied Healthcare Products Inc The RT200 Functions supported by the VT PLUS are listed below The full command set shown below is ava
55. Gas temp 0 51 Demo Data hh Ambient temp 0 51 Filtering iii Rel Humidity 0 100 Language jijj Correction Mode atp stpd btps Serial Mode kkkkk Barometric Press 762 5 Printer Options llll Baro Press units Printer type psig Kpa Bar Mbar Atm InH20 In Graphics Hg cmH20 mmHg Audio Levels mmmmmmmmmmm Breath General Detect BiDirection UniDirection Keypad Isp UniDirection Exp Off Errors nnnn Zero Mode auto manual Linearization Info 0000000000 Date 04 07 2000 HF Serial pppppppp Time 10 39 18 HF Checksum qqq Demo Data on off HF valid rrrrrr Filtering LF Serial soft medium hard none LF Checksum sssssss Language LF valid English german French Italian tttttttttt Serial Mode OTIS Ctrl Comp Ctrl None B 4 OTIS Control Transmit String Command Description Response String Name Settings SETTINGS uuuuuuuuuuuu Printer type ASCII 40 Char ASCII 80 Char None HP PCL3 Epson ESC P1 vvvvvvvvv Printer Graphics text only Graphics wwww Audio General low high off xxxx Audio Keypad low high off yyyy Audio Errors low high off 11111 Linearization HF Serial 65535 22222 Linearization HF Checksum Ffe6h 3333 Linearization HF valid yes no 44444 L inearization LF Serial 65535 55555 Linearization LF Checksum ffe6h 6666 Linearization LF valid yes no Note parameters returned will match those in the settings menus on the VT Plus This is the same data supplied in the manual settings me
56. N Put paper in printer Ensure the correct printer type is selected Refer to your printer s user manual to ensure the printer is setup correctly for the printer language set on the VT PLUS i e HP PCL 3 Note your printer may require special dip switch settings for a given printer language support Ensure that the printer cable is correctly installed Safety Error Messages Troubleshooting and Support 6 Troubleshooting Problem Possible Cause Corrective Action VT PLUS does not turn on Screen is dark VT PLUS screen turns on but is just white Splash may or may not appear before screen goes white Screen is difficult to read Flicker is observed on left side of VT PLUS screen No power Screen contrast not set Blown fuse Flash program memory not loaded Flash memory or boot memory resulted in incorrect checksum Screen contrast not set Screen contrast not set Slight flicker is normal Plug unit into an AC mains outlet using the supplied power cord Turn the switch on Adjust screen contrast using multiple pushes of the contrast key on the side of the VT PLUS display Replace fuse with one of correct rating as marked on the VT PLUS rear panel or as specified in the manual If problem persists call Servic If problem persists call Service Adjust screen contrast using multiple pushes of the contrast key on the side of the VT PLUS display Adjust screen contrast us
57. Service Center for VT PLUS software updates FLUKE Biomedical VT Plus Gas Flow Analyzer Designed by KORR Medical Technologies Figure 8 14 Flash Memory screen VT Plus for Windows 9 Plots Automatically Re scaling Plots By default the VT Plus for Windows 9 software will attempt to re scale plots so that the entire plot is visible to you When a re scale occurs the high and low ranges on the plots are determined by the min and max statistics for the signal shown on the plot The monitor plots and the single plot are re scaled every time they reach the end of the plot The loop plots are re scaled on every breath You may turn off the automatic re scaling by unchecking the box next to the plot s name in the PLOTS SCALING AUTO SCALE menu Auto scaling is automatically turned off for a plot if you manually re scale that plot Auto scaling can also be turned off by right clicking on a plot and unchecking the AUTO SCALE option Statistics Zero Setup Help Scaling Re Scale Ctri A Monitor Plot Monitor Plot2 Manual Scale b Monitor Plot 3 Single Plot Auto S cale b Auto Scale ll Ctrl Y Monitor Plot 1 v Monitor Plot 2 Y Monitor Plot 3 v Single Plot oop Plot 1 op Plot 2 ak Plot Y L Tv Lo v Le Figure 8 15 Scale Auto Scale Selecting the PLOTS SCALING AUTO SCALE function or clicking the RE SCALE NOW button on the tool bar forces an automatic
58. The following pages describe the supported commands and responses for the VT PLUS Name Enable causes the VT PLUS to enter the No Response Computer INIT computer control mode Control Terminate EXIT terminates communications between No Response Computer the VT PLUS and the PC Control Echo on ECHOspace XXX Enables disables echo of command ECHO XXX lt CR gt lt LF gt message in the returned result xxx ON or OFF XXX ON or OFF causes the VT PLUS to restore factory No Response Set Defaults DEF default settings Unit Serial SN Sends the VT PLUS serial number XXXXXXXX lt CR gt lt LF gt Number XXXXXXXX 8 digit serial number Settings SETTINGS causes VT PLUS to report the unit aaaaaalbbbbbbbblcccccccciddddddd settings dddleeeeeeeeeelfffffffffflgglhhliiiljjjj Ikkkkkll111 VT PLUS serial number mmmmmmmmmmnminnnnlooooooo Boot Version ooolpppppppplqqa rrrrrrisssssssltttttt Flash Version ttttluuuuuuuuuuuul Last Cal Date vvvvvvvvvlwwwwlxxxxlyyyyll111 Next Cal Date 11222221333314444415555516666 C Gas Settings R gt lt LF gt Gas type Gas temp aaaaaa vt plus serial number Ambient temp 123456 Rel Humidity bbbbbbbb Boot Version P1 01 00 Settings cccccccc Flash Version P1 00 22 Correction Mode dddddddddd Last Cal Date Barometric Press 02 29 2000 Baro Press units eeeeeeeeee Next Cal Date Breath Detect 02 29 2001 Zero Mode ffffffffff Gas type System air 02 heliox N20 bal 02 He bal Date 02 N2 bal 02 User Defined Time gg
59. This control allows you to specify the number of breaths that are drawn before the plots are cleared One to four breaths may be drawn before the plots are cleared UR T Plus for Windows cf x File Communications Plots Statistics Zero Setup Help Heceler eE Flow vs Volume 1062 5 Volume vs Pressure 120 81 72 51 844 1 24 22 6257 o0 li gt 24 08 407 2 Clear Volume 7237 1888 Clear Both 120 67 296 Number of Loops 469 2530 5228 7927 10625 635 235 165 566 966 E Volume Pressure Single Plot Screen A Loop Screen f Full Test Stacked Volume Test FILE DiBioTekWTPlusWimsSignalst LiterWaves vtp Figure 8 5 Loop screen 8 10 VT Plus for Windows Full Test The Full Test screen displays the calculated parameters for the last breath These parameters are only updated when a new breath occurs A value means that value is invalid or could not be calculated Depending on your breath detect mode some parameters can t be calculated 4 VT Plus for Windows B Monitor Screen Single Plot Screen 4 Loop Screen AMEI Lend Test 4 LeakTest 4 Stacked volume Test AME Figure 8 6 Full Test screen VT PLUS Operator s Manual Trend Test Overview The trend test is used for monitoring a single breath parameter over an extended period of time Each time a breath occurs the chosen breath parameter is compared to an initial value If it exceeds the percent limit
60. When measuring fluidic pressures it is important to realize any fluid that enters the pressure measurement port or the connecting tubing may cause a bias error in the measured pressure For example if a fluidic pressure measurement is made and a 5 cmH O column is in the connecting tubing an error of about 5 cmH5O may occur If fluid enters into the pressure measurements connections of the VT PLUS it is important to evacuate the fluid before storage and before any pressure measurements are made The fluid can be evacuated by connecting a 100 cc syringe directly to the pressure measurement connection and then pulling back the syringe to create a vacuum Internal Pressure Measurements The VT PLUS also has several internal pressure measurements These include barometric pressure differential pressure for the flow measurement and airway pressure The airway pressure is measured internally in the tube for the flow sensors This is done for convenience for the user while measuring ventilator parameters Having an additional pressure measurement for airway pressure i e besides the external low pressure measurement ensures that the pressure is measured at a consistent location and eliminates the need for cumbersome adapters for placing pressure taps in the airway circuit When the VT PLUS is set to measure from the high flow port the airway pressure is measured from the high flow port Likewise when the low flow range is selected the airway pr
61. a data file of raw waveforms The sig files are generated from the vtp files using a file conversion program Do this by selecting GENERATE A SIGNAL FILE from the VT Plus for Windows file menu bar Files must be closed to enable this option The sig files are in ASCII format and can easily be imported into your favorite spreadsheet They contain raw flow pressure volume auxiliary pressure and differential pressure time series collected at 20 ms time increments 50 Hz sample rate Generating Parameter par Files Parameter files store the breath by breath calculated ventilator parameters The par files are generated from the vtp files using a file conversion program Do this by selecting Generate a Param File from the VT Plus for Windows file menu bar Files must be closed to enable this option The par files are in ASCII format and can easily be imported into your favorite spreadsheet VT PLUS Operator s Manual 8 25 8 26 7 Printing You can print reports from the VT Plus for Windows software to any printer installed on your computer There are two ways to print from VT Plus for Windows Selecting PRINT from the FILE menu will bring up the system print dialog box This allows you to select which printer you want to use and adjust settings on that printer Clicking OK will send the report to the printer The second way to print is to click the PRINT button on the tool bar This does not bring up the print dialog T
62. abeled FILTERING 3 Press the MODIFY soft key until desired option is displayed 4 Press the BACK soft key to return to menu options Display Calibration Date on Startup Screen Use this option to control whether the calibration due date appears on the startup screen To select whether the calibration due date is shown on the startup screen follow these steps 1 Enter the system screen from the setup menu 2 Use the and or v soft key to highlight the line labeled DISPLAY CAL DATE 3 Press the MODIFY soft key until the desired option is displayed System Setup 4 Press the BACK soft key to return to menu options Serial Mode Use this option to control what data is available through the VT PLUS serial port The possible options are OTIS Ctrl Refer to Appendix B Computer Control Commands Comp Ctrl Computer Control Specialized serial communications used by the VT Plus for Windows PC Software Contact your sales representative for the protocol if needed RT200 A serial mode which emulates the Allied RT200 serial communications None No serial communications To select the serial mode options follow these steps 5 Enter the system screen from the setup menu 6 Usethe and or v soft key to highlight the line labeled SERIAL MODE 7 Press the MODIFY soft key until the desired option is displayed 8 Press the BACK soft key to return to menu options Printer Options This setting allows you to choose the for
63. acing the Hai LEE 7 3 Error Messages eee ee E e Red lia dd 7 4 itroubleshootlrig s iue cote ruo toc cte Tees etg ide es nibo ela 7 7 Returning the VT PLUS for Service sssssssssseeeeeeeneenene nennen 7 12 Chapter 8 VT Plus PC Software Getting Started ss oe tt oe tede pee repite dre 8 1 System Requirements ise 2 e eee ET HR RE HH ERRARE EE 8 1 Connecting to the VT PLUS sssssssseeeeneeeeeenenennenee nennen nennen nnns 8 1 Installing the Software sessssssseeeeeeeennnee nennen 8 2 Starting the Software inii n aa e rare 8 2 Overview of VT Plus for Windows Software sse 8 3 Purpose and Intended Use c ccceseseecesseceeeseneeeeeseeeeseseeeeneseeeeeseseeeneneineetegs 8 3 Using the VT Plus Software ssssssssssssssesee esee 8 3 Menus and the Toolbar ennn a E nennen nennen nnne nnn 8 5 Pulldown Men s 2 a te on eie ar a a ap aaaea 8 5 Toolbar Description e nitent RR HU RERO ERRARE pP RRRA 8 7 Screens and Tests oiii Decr ee eager ive ce epa ve Y e eye EY eg es 8 8 Main Screg hS sce reci aaa 8 8 Monitor SC een edem eL ect te e cedes ens 8 8 Single Plot Screen i eth ee eee ee resti te Save 8 9 LOOP Plots Screen bro REDEEM ie aE EA E ASR 8 10 Pull Testi tiet rtc es cone eter te e Dee euo co ED epe res 8 11 Trend Test in einer pee aa 8 12 Leak lest SCree vcs ou ade ee rere cid dba Ere rie pd 8 15 Stacked Vol
64. and smaller numbers will yield a fast playback speed 8 23 8 24 Event Markers Event markers have been provided to assist you during data collection There are two events that you the user can place into the file TIME STAMP and ANNOTATE During file recording these events will appear in the EVENT panel on the File Controls Interface Time Pressing this button during recording places a time stamp in the data file A dialog box will appear showing the exact time that was written to the file One use of this function is to correlate data collection in a laboratory notebook or data collection worksheet with the data in the file Annotate Pressing this button during recording brings up a dialog box where you may enter notes text Upon pressing OK your notes and a time stamp is placed in the data file It should be noted that the time stamp is the time that the OK button was pushed not the ANNOTATE button Automatic Event Markers Automatic event markers are placed in data files to assist in the rewind and forward functions during playback Recall that rewind and forward simply move the data file from event to event In the absence of user events i e Time or Annotate there would simply be beginning and end of file events You may adjust the time intervals between automatic events To set the time interval select TIMED BREAKS form the FILE menu This will bring up the following dialog box C 30 Sec c 1 Min
65. as Type Air Gas Temperature El c Ambient Temp el c Rel Humidity El E Settings can be set to pre selected options or to numeric values Following is a detailed description of each of the options Gas Type The possible options for GAS TYPE are as follows gt Note VT PLUS Operator s Manual Air N NO CO O Heliox N50 bal O He bal O N bal O User Defined Standard room air 100 Nitrogen 100 Nitrous Oxide 100 Carbon Dioxide 100 Oxygen 30 Oxygen and 70 Helium blend Measured Oxygen balance Nitrous Oxide Measured Oxygen balance Oxygen Helium Measured Oxygen balance Nitrogen User selects custom gas mixture This option requires the VT Plus PC software For BALANCE gas settings the oxygen concentration is measured using the VT PLUS oxygen sensor located on the high flow port If the low flow port is to be used allow gas to flow through both the high and low flow port so that the oxygen can be measured 4 3 4 4 To select GAS TYPE follow these steps 1 Use the and or v soft keys to highlight GAS TYPE 2 Press MODIFY until the preferred gas type is displayed 3 Press BACK to return to the settings menu Gas Temperature This setting is the temperature of the gas flowing through the high or low flow port The VT PLUS uses this information to improve the accuracy of the flow measurements All temperatures are in degrees centigrade To enter a new temperatur
66. barometric pressure measurement is provided by the VT PLUS The barometer can read absolute pressures from 8 to 18 PSIA The barometer is also used in the automatic ATP BTPS and STPD conversions for flow and volume measurements The barometric pressure signal can be fine tuned using the setup described in Chapter 3 System Setup High Pressure Measurement The high pressure measurement is made from a dual port connection consisting of a positive and a negative pressure port The differential pressure range is 100 psi This pressure measurement can be used for any pressure differential or gauge pressure in the given range The transducer is capable of measuring fluid pressure on the positive port as indicated on the label Oxygen Concentration Oxygen is measured through the high flow port of the system on the rear panel bulkhead fitting The range for this sensor is 0 to 100 The oxygen cell is mounted inside the enclosure on the rear bulkhead for the high flow circuit The fuel cell will need to be replaced approximately once a year Oxygen readings are compensated for airway pressure Specifications Calculated Breath Parameters From the primary flow and pressure measurements the VT PLUS is designed to calculate the following parameters e Tidal volume e Minute volume e Breath rate e Inspiratory to expiratory time ratio LE ratio e Inspiratory and expiratory time e Peak inspiratory pressure e Inspiratory pa
67. cccccseceeeessccetesceeeeseeeeenenseneeseseeeeeseeeeeeseaeeeseseeeeeeseeeess 8 35 Appendix A Specifications cccseccseeeeseeesseesseeeseeeeeeeeeeeeeenseesseeeenseesseeeeeseeeseeeseeeeeeeets A 1 Appendix B OTIS Control iii da B 1 VT PLUS Operator s Manual xiii xiv Preface Overview Chapter 1 Introducing the VT PLUS Optional Accessories Theory of Operation About This Manual Introducing the VT PLUS The VT PLUS is a general purpose gas flow analyzer with special modes designed specifically for testing mechanical patient ventilators The VT PLUS measures bi directional flow in both high and low ranges as well as high and low pressure ranges Other features include Oxygen Concentration Measurement An integrated sensor measures the oxygen percent of the gas in the high flow channel of the VT PLUS Breath Parameters The V7 PLUS measures 17 parameters on each detected breath These parameters include tidal volume minute volume inspiratory and expiratory pressures lung compliance etc Selectable Units The V7 PLUS allows the user to select the desired units for each of the measured signals For example pressures can be displayed in mmHg kPa bar mbar atm inH O inHg cmH O or mmHg Leak Testing The VT PLUS allows the user to test the leak rate of a sealed vessel or test lung Trend Testing The VT PLUS provides an automated test to see if a predetermined parameter deviates from limits set by the us
68. conds Pressing the soft key labeled UNITS changes the unit of measurement for the displayed signal value Pressing the UNITS key repeatedly causes the instrument to cycle through the various possible units The selected units of measure will remain even though the mode has been changed or when the VT PLUS has been turned off The selected gas type appears in the area below the UNITS key PARAMETERS Every screen can display up to four breath parameters Tidal Vol 152H B ml FEF 52 38 LPM PIF 41 45 LPM Breath Rate T 3 bpm These parameters are only displayed if breath detection has been enabled See Chapter 6 Special Functions for instructions on how to enable breath detection Parameters are updated following every breath Units of measure for breath parameters are fixed See Appendix A for a listing of breath parameters and units The user can select which parameters are displayed for each of the modes Display Screens 2 Selecting Parameters The VT PLUS calculates 17 breath parameters for every breath Parameters Minute Yoli ml Breath Rate E Tidal Vol E Ex Time O PIF E In Time O PEF E Ex Hold O Base Flow O In Hold LI Compliance O IE Ratio O of O FIF O Baro Press O MAP O Gas O IPP O FEEF O Set all screens to the same The VT PLUS allows the user to select up to four of these parameters that will be displayed with each of the screens To select which parameters will be displayed for a specific
69. cted on the side panel of the VT PLUS for the port where the flow is being applied No airway pressure is Wrong flow range low vs From the flow screen ensure observed high flow selected that the range low vs high flow matches the range depicted on the side panel of the VT PLUS for the port where the flow is being applied ER RR Pressure is negative Pressure is being applied to Ensure that pressure is when a positive pressure the connection instead applied to the correct is applied of the connection connection Ventilator parameters VT PLUS in circuit Ensure the inlet side of the seem incorrect backwards VT PLUS is connected closest to the inspiratory hose from the ventilator In bi directional mode this means the inlet is near to the Y piece VT PLUS does not print Wrong printer type selected Select correct printer type on the VT PLUS Safety Error Messages Troubleshooting and Support Problem Possible Cause Corrective Action software VT PLUS Operator s Manual VT PLUS takes a long time to establish communications with PC Printer not setup for selected printer language Printer not connected This is normal Review printer s user manual to determine how to setup p
70. d Precautions The following precautions are provided to help you avoid damaging the system lt Caution Service Authorized service personnel should service the VT PLUS Only qualified technical personnel should perform troubleshooting and service procedures on internal components lt Caution Environmental Conditions Do not expose the system to temperature extremes Ambient temperatures should remain between 18 40 C System performance may be adversely affected if temperatures fluctuate above or below this range lt Caution Do NOT Immerse Clean only with a mild detergent and gently wipe down with a clean lint free cloth Preface Applicable Testing Standards The VT PLUS has been tested by an independent laboratory and meets the requirements listed here Safety Requirements USA UL 3101 1 Electrical Equipment for Laboratory Use Part 1 General Requirements Canada CAN CSA C22 2 No 1010 1 1992 Safety Requirements for Electrical Equipment for Measurement Control and Laboratory Use Part 1 General Requirements EC Directive EN 61010 1 Safety requirement for electrical equipment for 73 23 EEC measurement control and laboratory use Part 1 General Requirements VT PLUS Operator s Manual vii Viii Electromagnetic Interference and Susceptibility DX USA FCC Class A Warning Changes or modifications to this unit not expressly approved by the manufacturer could void the user s authority to operate
71. d Printer Time out Printer Busy Printer Paper Out Occurs when printer s select line doesn t stay high CORRECTIVE ACTION Ensure the correct printer type is selected Refer to your printer s user manual to ensure the printer is setup correctly for the printer language set on the VT PLUS i e HP PCL 3 Note your printer may require special dip switch settings for a given printer language support Ensure the printer cable is correctly installed Occurs when a time out occurs while trying to write to the printer CORRECTIVE ACTION Ensure the correct printer type is selected Refer to your printer s user manual to ensure the printer is setup correctly for the printer language set on the VT PLUS i e HP PCL 3 Note your printer may require special dip switch settings for a given printer language support Ensure the printer cable is correctly installed Occurs when printer s busy line is set CORRECTIVE ACTION Ensure that the printer is selected refer to printer s user manual Ensure the correct printer type is selected Refer to your printer s user manual to ensure the printer is setup correctly for the printer language set on the VT PLUS i e HP PCL 3 Note your printer may require special dip switch settings for a given printer language support Ensure the printer cable is correctly installed Occurs when the printer reports an out of paper error Not all printers report this condition CORRECTIVE ACTIO
72. d expiratory breath detect modes if measurements cannot be made in the bi directional mode Additional breath detect modes were implemented for users that are accustomed to performing measurements with flow devices that can only measure flow in one direction Base Flow In the inspiratory and expiratory limb of the breathing circuit some ventilators may have a bias flow when no flow is going to or from the patient test lung This is implemented differently on different ventilators This is also called by different names by the various ventilator manufactures It may be called base flow bias flow flow by blow by or many other names In the inspiratory or expiratory only breath detection modes the VT PLUS can measure the base flow present Refer to Chapter 2 Installation for circuit configurations for the different modes The detection and calculation of base flow may take 30 to 60 seconds In expiratory only mode detection of base flow requires a sufficient end expiratory period and sufficient change in pressure The use of lower lung compliance settings improves performance in expiratory mode During expiratory only mode the base flow is subtracted from the flow signal for obtaining the ventilator parameters such as tidal volume and peak flow During inspiratory only mode the base flow is not subtracted since the base flow is typically turned of during the inspiratory phase on most ventilators VT PLUS Operator s Manual 1 7 Calcula
73. de and the gas correction mode set to ATP stroke syringe such that flows are near the mid range for the flow sensor Compare the VT PLUS tidal volume to calibration syringe volume If difference is out of specification return unit for calibration Gas settings are incorrect Review VT PLUS gas settings Correction mode is set to BTPS or STPD instead of ATP Set gas mode to appropriate setting for your application Most applications may require the ATP mode BTPS or STPD correction method on the VT PLUS is different that the method used by the ventilator manufacturer Corrections for BTPS and STPD may vary among different ventilator manufactures The biggest difference is in the water vapor volume correction The VT PLUS uses the setting for relative humidity and temperature to determine the actual volume of water vapor in the flowing gas This volume is subtracted from the total volume for dry gas corrections For saturated gas correction a make up volume of water vapor is computed and added to the measured volume Safety Error Messages Troubleshooting and Support Problem Possible Cause Corrective Action Compliance of breathing circuit tubing is causing a compressible volume loss Determine the breathing circuit compliance to calculate the expected volume loss due to compressibility of the gas and expansion of the hose detect mode The VT PLUS is used
74. detect mode Ensure that the VT PLUS is placed between the Y of the breathing circuit and a test lung Zero the affected signal by using the zero key while the affected signal is being displayed For example low pressure can be zeroed while the low pressure screen is currently displayed 7 9 Problem Possible Cause Corrective Action No message appears to Autozeroing mode is This is normal Since the remove flow when enabled autozero mode is enabled attempting to zero flow VT PLUS is zeroing flow the VT PLUS assumes that Appears that system will but no message is ine UNIREA How EN be used to obtain the zero not zero flow No supposed to be displayed reading message appears since the VT PLUS uses valves to switch to the Ensure the unused flow unused flow port sensor has zero flow when the autozero mode is AAA gt HAIR eu Zeroing flow results in Flow was not zero Ensure that there is no flow unexpected flow readings when zeroing the flow or an error message sensor Autozero mode was Whenever the autozero enabled and the unused mode is enabled ensure that flow sensor had a non zero there is no flow on the flow present unused flow sensor Barometric pressure is Barometric pressure offset Enter correct barometric incorrect drift pressure No flow measurement is Wrong flow range is From the flow screen ensure observed when flow is selected that the range low vs high applied flow matches the range depi
75. dical Corporation makes no warranty whatsoever regarding the condition of used products Fluke Biomedical Corporation warrants the instrument hereinafter collectively referred to as Products or Product for a period of one 1 year from the original purchase date against defective materials or workmanship This Warranty is limited to the original purchaser the Purchaser and cannot be assigned or transferred All claims under this Limited Warranty must be made in writing to Fluke Biomedical Corporation Attention Service Department Purchaser must ship the Product to Fluke Biomedical Corporation postage pre paid Fluke Biomedical Corporation shall either repair or replace with new or like new at its option and without cost to the Purchaser any Product which in Fluke Biomedical Corporation s sole judgment is defective by reason of defects in the materials or workmanship This Warranty is VOID if the Product has been damaged by accident or misuse or has been damaged by abuse or negligence in the operation or maintenance of the Product including without limitation unsafe operation operation by untrained personnel and failure to perform routine maintenance This Warranty is VOID if the Product has been repaired or altered by persons not authorized by Fluke Biomedical Corporation or if the Product has had the serial number altered effaced or removed This Warranty is VOID if any of the Products has not been connected installed or ad
76. dicates that the reported tidal volumes are measured over the expiratory phase of the breath This only applies to the bi directional breath detect mode Light Soft Filtering This indicates that the filtering option is turned on and the filter is set to light or soft filtering In this mode all of the signals flow and pressure have a Digital Signal Processing DSP low pass filter applied This is used when measuring very noisy signals None of the ventilator parameters are valid when the filtering is turned on Display Screens F Medium Filtering This indicates that the filtering option is turned on and the filter is M set to medium filtering In this mode all of the signals flow and pressure have a Digital Signal Processing DSP low pass filter applied This is used when measuring very noisy signals None of the ventilator parameters are valid when the filtering is turned on Hard Filtering This indicates that the filtering option is turned on and the filter is set F to hard filtering In this mode all of the signals flow and pressure have a Digital Signal Processing DSP low pass filter applied This is used when measuring very noisy signals None of the ventilator parameters are valid when the filtering is turned on STATISTICS On each of the screens except full breath parameters and monitor the minimum maximum and average of the plotted value are displayed to the right of the plot Stat
77. e follow these steps 1 Use the and or v soft key to highlight the line labeled GAS TEMPERATURE 2 Press the MODIFY soft key 3 Use the numeric keys to enter the temperature in degrees centigrade 4 Press the ENTER soft key to exit back to the menu options or to cancel the change press the ESCAPE soft key Note that the VT PLUS accepts temperatures between O and 99 C No decimal values or fractions of a degree are allowed Ambient Temperature This setting is the room temperature air flowing through the high or low flow ports To change ambient temperature follow these steps 1 Use the and or v soft key to highlight the line labeled AMBIENT TEMP 2 Press the MODIFY soft key 3 Use the numeric keys to enter the temperature in degrees centigrade 4 Press the ENTER soft key to exit back to the menu options or to cancel the change press the ESCAPE soft key Relative Humidity This setting is the relative humidity in the air flowing through the high and low flow ports To change relative humidity follow these steps 1 Use the and or v soft key to highlight the line labeled REL HUMIDITY 2 Press the MODIFY soft key 3 Use the numeric keys to enter a new value 4 Press the ENTER soft key to exit back to the menu options or to cancel the change press the ESCAPE soft key System Setup D4 Note Only dry gases should be used with the VT PLUS Do not use with heated humidified gases The Relative H
78. e close button on the toolbar Note VT Plus for Windows does not store data in a buffer temporary file If a file is not open and the software is recording no data will be saved RECORDING is described in File Control Interface on page 8 22 VT PLUS Operator s Manual 8 21 8 22 File Control Interface The File Control Interface is a sub screen used for recording annotating and playback of data files You can bring up the File Control Interface by selecting the file control button on the toolbar or by selecting FILE CONTROLS from the file menu bar There are four main panels or sections in the File Controls Interface Playback Controls Event Markers File Information and Event xt Stopped Al xl Playback Controls E peg pe mj a 1 cn Speed Control 90 File Information CAProgram FilestvyTPlusiSignalst Lite 3 08 13 PM Subject Just Testing Files Investigator Brooks Event Markers Annotate Time Event 3 08 13 PM 2 15 22 PM Figure 8 11 File Control Interface VT Plus for Windows Playback Controls The following controls are provided to aid in data review and recording s RECORD LO pay E e E Speed Control 10 LIL VT PLUS Operator s Manual STOP PAUSE BEGINNING OF FILE REWIND CONTINUOUS PLAY FORWARD END OF FILE SPEED CONTROL The record button initiates writing data to
79. ennen nennen 30 psi Span Accuracy ssss 0 50 of reading or 1 5 mmHg whichever is greater Frequency ROSAS ci RE RN AERE gt 10 Hz Fiesolutlori i rette un ange eb pee 0 1 mmHg Sample Rate odpailbu eni eite deno 100 Hz PX Note Fluid pressure may be applied to the positive port however fluids should be kept from entering the pressure port by using a suitable length of connection tubing High Pressure Port Maximum Applied Pressure oooooconoccccnnoocccnoncccnnnoncnonnnon cnn non oncnnnnn nro rnnr enne 150 psi Operating PressuUre ii a 100 psi Span Accuracy ccccocccnccccnonccancnnnnnanancnnnnos 1 of reading or 0 1 psig whichever is greater Frequency Response 2 ne Lee a ce s gt 10 Hz Riesol tion AA AAA actu 0 1 psi Sample Rate iio b at ec ede s 100 Hz PX Note Fluid pressure may be applied to the positive port however fluids should be kept from entering the pressure port by using a suitable length of connection tubing Specifications Airway Pressure Maximum Applied Pressure ssseeneeeneeeeen meer 20 psi Operatirig PressUre i trt eee pe bte eig te a 120 cmH20 Span Accuracy ssss 0 75 of reading or 0 5 cmH20 whichever is greater Frequency Response sees gt 25 Hz or t10 00 40 ms whichever is greater Resol i a tchat edet ftc etg Wet taal hadnt dete 0 1 cmH20 Sample rale ect o DG En e ueni ile tue te d eie etude 10
80. enter the compliance in l cmH5O Be sure to use leading zeros so that a number is entered for all of the 5 digits VT PLUS Operator s Manual 6 5 To enter the duration of the leak test press the and v soft keys to highlight TEST TIME Press the soft key below MODIFY Press the numeric keys to enter the duration of the leak test in hours minutes and seconds Six digits must be entered to set the test time The time is entered in the following format HHMMSS HH is the hours 0 99 MM is the minutes 0 59 and SS is the seconds 0 59 Be sure to use leading zeros to enter values less than 10 For example to enter a time of 1 09 05 press the following sequence of keys 0 1 0 9 0 5 After all of the test parameters have been pressurize the test chamber test lung and press the soft key below START A screen similar to the one shown will be displayed Leak Test Compliance B B mlcmH2 0 Vol Lost BH aL Start Press 4 B4 Kpa Leak Rate 666 cmHz 0s Start Time 11 16 38 Time Left 6 29 26 The display shows a pressure plot and instantaneous pressure valued to the right of the plot Parameters below the pressure plot show the entered compliance the time of day that the test was started and the calculated test results The test is terminated when the STOP soft key is pressed or when the test time has elapsed In either case a leak test result is displayed when the test is ended A sample Leak Test Report is shown on the follo
81. er Evaluations Troubleshooting The V7 PLUS can be used for pre purchase evaluations of ventilators incoming and routine performance verification and troubleshooting clinical problems as well as teaching principles of mechanical ventilation 1 2 2 Optional Accessories The utility of the VT PLUS can be extended with the following optional accessories Graphics Printer This instrument is designed to interface with a printer With the printer attached flow and pressure values and breath parameters can be printed See Chapter 2 Installation for printer operation Computer Control and Data Logging A standard bi directional RS232 serial port allows connection to a personal computer for external VT PLUS control and data logging of test results The instrument is compatible with Fluke Biomedical s OTIS Test Integration Software program as well as special purpose data logging PC software See Chapter 8 VT Plus PC Software Lung Simulator The VT PLUS will operate with or without a test lung attached The use of a test lung with integrated airway restrictors will assist the operator in evaluating intermittent errors Overview 3 Theory of Operation This section of the manual describes how the VT PLUS performs computations of the information it displays The VT PLUS measures the basic signals of pressure flow and oxygen From these basic signals other parameters are computed Volume is obtained from the integration or summation
82. er the bi directional mode is preferred Bi directional Flow Mode 1 Connect the ventilator using a Y piece adapter to the flow inlet port on the right of the VT PLUS 2 Connect the flow exhaust port on the left to the test lung using standard breathing hoses 3 Ensure that the breath detection mode is set to bi directional a Gointo Setup 8 b Choose Settings c Choose Breath Detect and modify as needed Refer to Figure 2 1 See Chapter 4 System Setup for more details Venen Hose Lung L Outlet Ventilator Ze L MR Hose Figure 2 1 Connecting the VT PLUS between the ventilator and load test lung in a bi directional flow mode VT PLUS Operator s Manual 2 3 Uni directional Flow Mode Alternatively the VT PLUS can be used to measure only inspiratory or expiratory gas flow as shown in Figures 2 2 and 2 3 Inspiratory Testing 1 Connect the inspiratory hose to the flow port on the right of the VT PLUS 2 Connect the flow exhaust port on the left to the test lung using standard breathing hoses 3 Ensure that the breath detection mode is set to Uni directional Inspiratory a Gointo Setup b Choose Settings c Choose Breath Detect and modify as needed See Chapter 4 System Setup for more details Inlet Outlet a Inspiratory Hose Ventilator Ji nes Hose ja Figure 2 2 Connecting the VT PLUS to in either the inspiratory limb of the breathing circuit E
83. es for the calculated parameters Clicking the PRINT button prints out a final report for the leak test Click on the NEW TEST button to start a new leak test VT PLUS Operator s Manual 8 15 T Plus for Windows EN A Monitor Screen f Single Plot Screen f Loop Screen f Full Test Trend Test A A Stacked Volume Test 0 Figure 8 8A Leak Test screen T Plus for Windows Low Pressure A Monitor Screen f Single Plot Screen f Loop Screen f Full Test f Trend Test A f Stacked Volume Test Figure 8 8B Leak Test screen 8 16 VT Plus for Windows Stacked Volume Test Overview The stacked volume test measures tidal volumes over a given number of breaths and calculates the average tidal volume Starting a Stacked Volume Test To start the stacked volume test just enter the number of breaths that you want averaged Click the START button to begin testing Running the Stacked Volume Test When the stacked volume test begins the VT PLUS will switch into Inspiratory Only breath detect mode At the end of the test the breath detect mode will be restored to its previous state The stacked volume test reports five values to the user These values are updated every time a breath is detected Total Volume This value reflects the total of the tidal volumes for the breaths tested Last Volume The tidal volume for the last breath is displayed here Average Volume The average tidal volume ove
84. ess than the minimum reading of the analog to digital converter CORRECTIVE ACTION Ensure that pressure is within the specified range of the VT PLUS Occurs if low pressure measurement causes a measurement greater than the maximum or less than the minimum reading of the analog to digital converter CORRECTIVE ACTION Ensure that pressure is within the specified range of the VT PLUS Occurs when high pressure measurement causes a measurement greater than the maximum or less than the minimum reading of the analog to digital converter CORRECTIVE ACTION Ensure that pressure is within the specified range of the VT PLUS Occurs if either of the linearization tables for the high and low flow sensors are invalid at startup If this condition is detected linearization tables aren t used to calculate flow Accuracy could diminish by 3 to 1096 CORRECTIVE ACTION Call Service Safety Error Messages Troubleshooting and Support Negative Flow Detected No Load Applied AD Buffer Overrun Zero Time Out Transmit Buffer Overflow No Printer Selected VT PLUS Operator s Manual Occurs when an average negative flow is detected in either inspiratory only or expiratory only breath detect mode CORRECTIVE ACTION If error message repeats the VT PLUS is installed in the ventilator circuit backwards Ensure the INLET flow connection on the VT PLUS is nearest to the INSPIRATORY hose from the ventilator Occurs when the
85. essure is VT PLUS Operator s Manual 1 3 measured from the high flow port In both cases the airway pressure measurement is made on the exhaust side of the flow sensor Zeroing the Pressure Signals The zero reading offset of the pressure measurements may drift slightly with time and temperature A zeroing function is provided for the user to zero the offset drift Typically this is done when a non zero reading occurs when there is zero applied pressure However it is good practice to zero the respective signal before any measurement is taken A warm up period is suggested as the VT PLUS is turned on The offset drift will be most significant while the sensors for the pressure measurements are warming up If the warm up period is skipped be aware that the offset drift may be significant in the first few minutes of operation If the VT PLUS has been through an extreme temperature change additional time may be required for the warm up If the VT PLUS has only been turned off for say a minute the warm up period may be skipped The zeroing function for pressure acts as a tare function As such the applied pressure when the signal is zeroed will be saved as the new zero reading The applied pressure during zero would then be read as zero Measured pressures would have an offset error equal to the applied pressure when the VT PLUS was zeroed Airway Zeroing A Special Case The airway pressure may be zeroed manually using the ZERO key
86. eturned value in mmHg xxx lt CR gt lt LF gt xxx offset value from measure barometric pressure in mmHg aaa albbb blecc cclddd ddleee eelf ffl g gglh hhli iiljjj jIKkk kllIl lmmm ml nnn nnlooo olppp plqqqqqqlrr rlss s CR gt lt LF gt aaa a is the tidal volume TV in mls bbb b is the minute volume MV in mls ccc cc is the peak expiratory flow PEF in L min ddd dd is the peak inspiratory flow PIF in L min eee ee is the compliance in ml cmH20 f ff is the expiratory time in sec g gg is the inspiratory time in sec h hh is the expiratory hold time in sec liiis the inspiratory hold time in sec B 6 OTIS Control Command Transmit String Command Description Response String Name o Bn V Minute MV the volume of gas expired in one Volume minute Inspiratory to IERATIO ratio of the inspired time to the Expiratory expired time Time Ratio LE Ratio Inspiratory inspiratory time Time D CMT Time Inspiratory IHOLD Ti x 0 01 seconds Hold Time Expiratory EHOLD Te The x 0 01 seconds Hold Time Mean Airway the mean pressure over the entire Pressure breath Peak Expiratory Flow Peak Peak Inspiratory Flow Inspiratory Flow Peak Expiratory Flow Breath Rate the total breath rate calculated as 1 Ti Te Peak Inspiratory Pressure Inspiratory Inspiratory Pause Pressure Pause Pressure VT PLUS Operator s Manual the peak pressure during the inspired period IT ET
87. fier maximum of 10 ten characters Unrecognizable commands return no response For commands that return a value out of range conditions return either an asterisk or a series of followed by lt CR gt lt LF B 2 OTIS Control Message Results Results provided by the VT PLUS are transmitted in the following format ABBBBB DDD lt CR gt lt LF gt A negative sign otherwise assume positive value No spaces value left justified BBBBB ranges from 0 99999 DDD ranges from 0 999 CR LF end of result The return values have variable length and are terminated by the gt CR gt lt LF gt delimiters ASCII code 13 10 A single message may contain several values Each value is separated with a pipe lt I gt character ASCII code xxx The actual format of the data is described in detail in the command definition section of this document The returned result may be prefixed with the command message if the ECHO ON command is enabled To enable ECHO ON the command ECHO ONG is sent to the VT PLUS The result format is as follows when the ECHO ON is enabled XXXspaceABBBBB DDD lt CR gt lt LF gt XXX command message Space space character A negative sign otherwise assume positive BBBBB ranges from 0 99999 DDD ranges from 0 999 lt CR gt lt LF gt end of result To disable ECHO ON send the command lt ECHO OFF gt VT PLUS Operator s Manual B 3 4 Command Types
88. for breaths affected by an autozero are discarded Airway pressure is also zeroed whenever flow is zeroed Airway pressure can also be independently zeroed from the airway pressure screen Overview Breath Detection To monitor ventilator parameters the VT PLUS must first determine when a breath occurred and delineate the various phases of the breath For example the breath detection algorithm determined the beginning and ending of the integration periods for calculating tidal volumes The breath detection algorithm was implemented as a state machine The flow waveform was the input to the state machine The state changes were based on flow waveform crossing of predefined thresholds A threshold was applied to both positive inspiratory and negative expiratory flows The breath detection threshold can be set to a high flow rate to reject noise near zero flow Bi directional Inspiratory Expiratory Breath Detect Modes Figure 1 1 shows the circuit connection for setting up the VT PLUS in a bi directional mode The gas flows in both directions through the VT PLUS This is the preferred setup for using the VT PLUS with a ventilator Ven Hose Lung Laa Outlet Expiratory Hose Figure 1 1 Circuit Connection for the VT PLUS in bi directional mode Ventilator lt Note When using the VT PLUS with a ventilator and a test lung the bi directional breath detect mode is preferred Only use the inspiratory an
89. he report is automatically sent to the default system printer The print header that appears at the top of the reports is stored in the VT PLUS It is loaded into the VT Plus for Windows Software every time it connects to a VT PLUS unit The print header can be changed using the PRINT HEADER function in the SETUP menu Loading Flash Memory The VT PLUS operating software is stored in flash memory onboard the VT PLUS VT Plus for Windows may be used as a utility to load new versions of operating software into the VT PLUS Caution Using this utility to load new versions of VT PLUS software will overwrite any user settings stored in the VT PLUS Loading new software via this utility will not change the calibration of the VT PLUS The procedure is as follows 1 Select FILE then LOAD FLASH from the menu The VT PLUS operating software is stored on two layers 1 flash code file operating code and 2 text 2 Use the Browse button to point to the file FLASH hex for the code file and VP TEXT hex for the text file 3 Press OK to begin downloading When communications are established the VT PLUS splash screen will be displayed and a LOADING FLASH dialog will appear on VT Plus for Windows with a status bar Figure 8 14 When the download is complete the VT PLUS will return to the default screen The download version can be verified by going to the information screen on the VT PLUS Please contact Fluke Biomedical s
90. hlight TEST PARAMETER Press the soft key below MODIFY until the breath parameter you wish to test is displayed The most recent measurement of the selected parameter will be displayed as the CURRENT VALUE Use the and v soft keys to highlight LIMIT Press the soft key below MODIFY then use the numeric keys to enter the percent change that will be considered a deviation from acceptable limits Percent values range from 1 to 99 Remember to enter leading zeros for values less than 10 For example 5 would be entered as 05 Press the soft key below ENTER after the percent value has been keyed in Trend Test Test Parameter Minute Vol Starting Time Ez x Ending Time 55 04 Elapsed Time DI SH Starting Value 000 x Limit x of Incidents of Tests Use the and v soft keys to highlight USE PRINTER Press the soft key below MODIFY If YES is selected for printer a report of all the breath parameters with time date stamp will print every time an incident occurs Before starting the test ensure that the ventilator is on and that steady state conditions are reached Monitor the CURRENT VALUE displayed to ensure that the breath parameter is as expected Press START to begin testing The trend test screen is displayed while the trend test is in progress The trend test screen shows the parameter being tested the starting and current values and the difference between the two values The allowable 96 deviation limit
91. hreshold Dialog Box VT PLUS Operator s Manual 8 31 Gas Settings The VT PLUS can compensate for the effects of gas temperature viscosity molecular weight and relative humidity on flow measurement as well as correct flow calculations to one of several standard conditions The Gas Settings option gives you access to these settings For more information on the gas settings refer to Chapter 4 System Setup To change the gas settings select GAS SETTINGS from the SETUP menu The following dialog box will appear and you can make the changes EUM Gas Settings Gas Settings Gas Type Air y Temperature 273 E Relative Humidity o 273 dE Gas Correctio Ambient Temperature Correction Mode ATP M Advanced y ox x Figure 8 21 Gas Setting Dialog Box By selecting the ADVANCED option the gas settings dialog box lets you adjust the temperature viscosity molecular weight and relative humidity for both the inhaled and exhaled gases Also you can adjust the ambient temperature and have the flow adjusted to one of six standard modes ATP BTPS STPD see Figure 8 3 8 32 VT Plus for Windows Gas Settings Data Entry Figure 8 22 Advanced Gas Setting Dialog Box D4 Note If you don t know the viscosity or molecular weight of the gas you are using click the GAS CALCULATOR button VT PLUS Operator s Manual 8 33 8 34 Gas Calculator The gas calculator allows you to
92. ht hand of the display will move indicating the plot area selected Press the soft key below ASSIGN to change which signal will be plotted in the selected position Four breath parameters can be displayed in place of a signal plot in the lowest position As described on page 5 5 of this chapter the user can select the parameters displayed in this screen Press the soft key below UNITS to change the units of the signal and the units of the instantaneous value for the plot in the selected position The possible units for each of the various signals are the same as the units that can be displayed in the screens that display that signal exclusively Press the soft key below RESCALE to change the scale on the selected plot to a more appropriate window of values Display Screens 9 Units of Measure The VT PLUS has the capability to display the above signals and parameters in the following units of measure Flow Ipm Liters per minute f min Cubic feet per minute l sec Liters per second ml min Milliliters per minute ml sec Milliliters per second Low High Barometric Airway Pressure PSIG Pounds per square inch gauge kPa Kilopascals bar 14 7 PSIG mbar millibar 001 Bar atm Atmosphere inH 0 Inches of water inHg Inches of mercury cmH 0 Centimeters of water mmHg Millimeters of mercury Volume Liters F Cubic Feet ml Milliliters The VT PLUS has the following c
93. ie EE bee EH ERE iii Restrictions and Liabilities eesssennmm n iii REVISION Record metia e Dette peer trea eto e teres E VOS Ee et iv All Rights Reserved ie e DRRTRRHRREARERRERCEHRERUERIERCRR HR SIDA iv Safety Considerations iieii aie nde aii V WarningS and GaUutions 2 21 e ert aa rede ode PRAES V Hazard WarningS irem beendet deri vi lwicie Iio que vi Applicable Testing Standards sssssssseseeeeeeeenennnen nennen nennen vii Safety Requirements 24 cire eene sez crede edle cre c UY npe deca test vii Electromagnetic Interference and Susceptibility ssessessss viii USAAEGGC CIASS Aci tee eee idea verre ctr e ioter nt viii Canadian Department of Communications Class A ussssssse viii EC Directive 89 336 EEC Electromagnetic Compatibility ix Emissions Class Anpe mne redet tempe tte ee nc ix lai ix EC Directive 73 23 EEC Low Voltage User Safety sss ix Warranty 5 reden EOD ED TO GC OG OR eR D BE x Chapter 1 Overview Introducing the VT PLUS ss once ale eed av eee is 1 1 Optional Aecessorlas 5 icon ternas 1 2 Theory of Operation cttm eret eee eet ede EI eee de recs 1 3 Pressure Measurement inicia erede isi vr eae pereo toda va cae roo Yu 1 3 Oxygen Measurements iissa cres anaishi aada ies aeaiia a nnne enne 1 4 Flow Measurements
94. ilable in firmware version 1 08 04 and higher Command Description F09 Reset F11 Low Pressure Measurement 20 cmH O F12 Low Pressure Measurement 250 cmH O F13 Low Pressure Measurement 185 mmHg F21 High Pressure Measurement 20 psi F22 High Pressure Measurement 100 psi F23 High Pressure Measurement 5170 mmHg F31 Low Flow Measurement 0 N2 F32 Low Flow Measurement Air F33 Low Flow Measurement O2 N20 F35 High Flow Measurement 02 N3 F36 High Flow Measurement Air F37 High Flow Measurement 02 N20 F41 Tidal Volume 0 N3 F42 Tidal Volume Air F43 Minute Volume 02 N gt F45 Respiratory Rate F46 Tinspiratory F47 Texpiratory F48 I E Ratio Special Functions The PEAK soft key toggles the RT200 peak detect mode on and off for flow and pressure signals When in peak detect mode the peak of the current signal flow or pressure is shown for each breath The RESET soft key resets the RT200 mode turning off any active functions and resetting the special functions The FCTN soft key brings up a menu that allows the user to start a RT200 function and enter the special function values associated with that RT200 function The menu is function sensitive and the options in the menu correlate to the RT200 s special functions 00 01 F1 and F2 The values you may set in this menu include Oxygen Concentration Accumulated Tidal Vo
95. ill be calculated Enter the test time to set the length of time that the leak test will run At the end of that amount of time the leak test will automatically stop Press the START button to begin the leak test Running the Leak Test While running a test you cannot change screens until the test is over The leak test plots the chosen pressure channel airway low or high pressure over the chosen length of time The leak test also displays several values that are calculated during the test Test Parameter This is the parameter that was chosen for running this test This value will not change during the test Compliance This is the compliance value entered when starting the leak test This value doesn t change during a leak test Initial Pressure This is the pressure read on the selected pressure channel when the leak test was started The initial value doesn t change during a leak test Start Time This is the time that the leak test was started Volume Lost If a compliance value was entered at the start of the leak test this value is the amount of volume lost during the leak test Leak Rate This is the rate at which pressure is being lost Time Remaining This shows the amount of time left in the leak test Ending the Leak Test The leak test will end either by the time running out or the user may terminate the leak test by clicking the STOP button When the leak test is over a report is prepared showing the final valu
96. ing The system is to be cleaned with a damp cloth on the exterior only A solution of 70 isopropyl alcohol may be used to remove stains and clean the system No other solvents are recommended Flow Port Filters Internal filters for protecting the flow sensors are only to be changed by qualified service personnel Flow Port Protective Caps Use high low flow protective caps when transporting to keep foreign debris from entering high low flow ports 7 2 2 Replacing the Oxygen Sensor The VT PLUS uses a galvanic oxygen sensor that is warranted for 12 months The oxygen sensor cell needs to be replaced when the oxygen calibration cannot be successfully completed The oxygen sensor may operate for longer than 12 months depending on use To replace the oxygen sensor follow these steps below A Disconnect the power cord before opening the oxygen sensor door PEA A Gels Oe S Remove the three screws in the oxygen sensor door on the back of the VT PLUS The oxygen sensor is a round plastic cylinder about one inch in diameter with wires protruding from the back of the sensor Disconnect the in line electrical connector on the sensor wire Un screw the old sensor and remove it Screw in the new sensor Fluke Biomedical P N 76046 Re connect the sensor wire Replace the oxygen sensor door Re calibrate the oxygen sensor following the instructions below 3 Procedure for Calibrating the Oxygen Enter the oxygen calibration scree
97. ing multiple pushes of the contrast key on the side of the VT PLUS display Adjust contrast to diminish effect Out of Range messages appear Measured signals out of specified range Ensure that all pressures and flow rates are within the VT PLUS specified limits Units are not set to those used for the range specifications User mistakenly assumes that range is not exceeded due to readings in the different units For example monitoring pressures in psi while trying not to exceed a range specified in cmH2O Ensure the units selected are the same as the specified limits VT PLUS Operator s Manual Unit calibration is incorrect If problem persists call Service 7 7 7 8 Problem Tidal Volumes are erratic in bi directional breath detect mode Tidal volumes different than expected Possible Cause Breath detection threshold set too low Noise from ventilator is causing false breaths User s expected value was incorrect Corrective Action Set the breath detection threshold to a higher value Review expectations Flow baseline drifts causing a false non zero flow reading when flow was actually zero Zero the flow reading Consider using the auto zero mode VT PLUS is out of calibration If possible verify calibration with a 3 liter calibration syringe Ensure gas settings are correct With the VT PLUS in the bi directional breath detect mo
98. ing the VT PLUS The VT PLUS serial port uses a standard 9 pin serial connection Simply plug a serial cable into the RS232 port on the back of the VT PLUS and into an unused serial com port on your PC VT PLUS Serial Mode Communication Parameters The VT PLUS must be placed in the proper serial mode before attempting to communicate with the PC To do this press the SETUP key and then select SYSTEM Move the cursor to the line SERIAL MODE using the up down cursor soft keys Press the MODIFY soft key to select the option OTIS CTRL The communication protocol of the VT PLUS is fixed as follows when operating in the computer control mode e Baud Rate 2400 e Parity None e Data Bits 8 e Stop Bits 1 Establishing Communications Communications are established by sending the INIT command message prefixed with the colon lt gt character e g INIT when the VT PLUS is at the default state The reception of the INIT command will cause entry into computer control The VT PLUS screen will change to the computer control screen to indicate that computer control mode is established Conversely communications are terminated by sending the command EXIT to the VT PLUS The VT PLUS will return to the default screen upon exiting The front panel keypads are disabled when communications are established via computer control with the exception of the lt SETUP gt key to manually exit computer control When communications are estab
99. istics Mint 53 5 Maxi 37 2 Avg A These values are calculated continually until a new screen is selected or until the soft key labeled CLEAR is pressed DATA PLOTS Each of the screens except the FULL screen includes a data plot 3 22 32 EB Each of these plots shows a measured signal flow pressure volume or O2 vs time New data is added to the plot starting on the left and progressing to the right When the plot has progressed to the right edge the plot restarts on the left side of the plot One line of data from the previous plot is removed ahead of the new plot When a new screen is selected the plot is displayed using a default plot range Pressing the soft key labeled CLEAR restarts the plot and clears all previously plotted data Pressing CLEAR also clears the calculated statistics Pressing the RESCALE key changes the window of the data plot to a range of more appropriate values based on the min max values in the statistics section lt Note Allow one full cycle to pass before pressing RESCALE after CLEAR has been pressed The new scale on the plot will be based on the minimum and maximum values in the Statistics area VT PLUS Operator s Manual 5 3 5 4 INSTANTANEOUS NUMERIC DATA To the right of each plot the digital value of the plotted signal is displayed I Ad LPH This value is updated approximately twice a second This value is the average of the signal over the previous 500 millise
100. justed strictly in accordance with written directions furnished by Fluke Biomedical Corporation Batteries fuses light bulbs and other consumable items used in any of the Products are not covered by this Warranty Software utilized in conjunction with any of the Products is not covered by the terms of this Warranty but may be covered under a separate Fluke Biomedical Corporation software warranty We will continue to stock parts for a maximum period of five 5 years after the manufacture of any equipment has been discontinued Parts shall include all materials charts instructions diagrams and accessories that were furnished with the standard models THIS WARRANTY CONTAINS THE ENTIRE OBLIGATION OF FLUKE BIOMEDICAL CORPORATION AND NO OTHER WARRANTIES EXPRESSED IMPLIED OR STATUTORY ARE GIVEN PURCHASER AGREES TO ASSUME ALL LIABILITY FOR ANY DAMAGES AND OR BODILY INJURY OR DEATH THAT MAY RESULT FROM THE USE OR MISUSE OF ANY EQUIPMENT OR INSTRUMENT BY THE PURCHASER HIS EMPLOYEES AGENTS OR CUSTOMERS OTHER THAN THE EXPRESS WARRANTY CONTAINED HEREIN WE SHALL NOT BE RESPONSIBLE FOR ANY DIRECT OR CONSEQUENTIAL DAMAGES OF ANY KIND THIS WARRANTY SHALL NOT BE CHANGED OR MODIFIED IN ANY WAY WITHOUT THE EXPRESS WRITTEN PERMISSION OF AN OFFICER OF FLUKE BIOMEDICAL CORPORATION THIS WARRANTY IS VOID UNLESS THE PURCHASE REGISTRATION CARD HAS BEEN COMPLETED AND MAILED TO US WITHIN TEN 10 DAYS OF PURCHASE X Preface Contents Noticia a et
101. key The AUTO soft key will start the HFO test in automatic mode In automatic mode the HFO test is run every 15 seconds When in automatic mode press the STOP soft key to end the high frequency oscillator test Special Functions Safety Error Messages Troubleshooting and Support Chapter 7 This chapter provides enough information to help the user troubleshoot possible VT PLUS failures and perform diagnostics Service of the VT PLUS other than replacement of minor components such as the fuse and O sensor should be left to qualified Service personnel Calibration of the tester should also be left to qualified Fluke Biomedical Service personnel to ensure that the VT PLUS remains under warranty Electrical Safety and System Maintenance Replacing the Oxygen Sensor Procedure for Calibrating the Oxygen Replacing the Fuses Error Messages Troubleshooting Returning the VT PLUS for Service 1 Electrical Safety and System Maintenance For safe operation the main power cord must be plugged into a power outlet that has a protective earth contact to connect the chassis of the VT PLUS to ground Do not use extension cords without earth ground or a hazardous condition may result A Warning Hazardous Voltages Present For safety purposes and to avoid damaging the instrument you must turn off the VT PLUS and disconnect its power cord BEFORE opening the case or performing other service procedures described in this chapter Clean
102. led RESTORE DEFAULTS 3 Press the MODIFY soft key 4 After a few seconds a series of beeps indicates defaults have been restored 5 Press the BACK soft key to return to menu options 4 Utilities These settings are required for servicing the operations of the VT PLUS This information is for service personnel involved in the technical repair of the VT PLUS Utilities Oxygen Calibration System Diagnostics Linearization Unlock Calibration Oxygen Calibration Select OXYGEN CALIBRATION to calibrate the oxygen sensor Refer to Chapter 7 for details on oxygen calibration System Diagnostics These functions are for the service personnel to utilize during the technical repair of the VT PLUS System Setup Linearization This option will be of most use to service personnel repairing the VT PLUS The calibration data for each sensor is stored so a checksum test can be performed to make sure the sensor data is still valid 1 Enter the settings screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled LINEARIZATION 3 Press the ENTER soft key 4 Press BACK to return to menu options Linearization Info HF Serial 1004 HF Checksum 6830h HF Valid Yes LF Serial 100 1 LF Checksum 6784h LF Valid Yes Unlock Calibration These functions are for the service personnel to utilize during the technical repair of the VT PLUS 5 Information This setting gives the prod
103. lished between the PC and the VT PLUS the serial mode screen Menu 11 will display NO GRAPHICS ARE AVAILABLE WHILE SERIAL COMMUNICATIONS ARE ACTIVE indicating that serial communications are enabled You may disable the serial communications by pressing the SETUP key and following the above steps selecting NONE as a serial mode option 3 Message Structure The VT PLUS carries out actions in response to the commands received from the PC and send messages back in response The VT PLUS does not send any commands or messages to the PC on its own It only responds to commands sent by the PC Both commands and messages are implemented as ASCII strings No binary data is exchanged Messages are of variable length and are delineated via an end of result terminator Results are automatically transmitted after completion of each test command Each test command runs until a result is determined whether it is a valid result or a failure Command Messages Command messages sent to the VT PLUS have the following format XXX lt CR gt lt LF gt XXX the command from the PC lt CR gt ASCII code 13 carriage return delineates every command message lt LF gt ASCII code 10 line feed delineates every command message Commands and data are case insensitive Some commands may contain modifiers The command modifier is separated from the command using the space character as follows Xxxspaceyyy XXX command space command separtor yyy command modi
104. lumes Correction Mode Hold Times Ambient Temperature Barometric Pressure Rise Delay Time Fall Delay Time and Trigger Level RT 200 Function HI De Concentration 100 Volume Accum I Correction Mode ATP Ambient Temp TD Rise Delay Time 50 Fall Delay Time 100 Trigger Level Low Turn Off RT200 Emulation The SETUP RS232 soft key brings up a screen for setting the baud rate number of data bits and the terminator character These settings only affect the RT200 emulation mode and not the other serial communication modes The default settings are 9600 baud 7 bits and a termination character of carriage return only RT 200 Baud Rate 4600 Data Bits 7 bits Terminator CR Only VT PLUS Operator s Manual 6 11 6 12 5 Assist Test The assist test is used to determine the sensitivity of the ventilator in patient assist mode and to calibrate the full range of assist pressures under which the ventilator can operate During an assisted breath the airway pressure drops during the inspiration due to the spontaneous breath AIRWAY PRESSURE ASSISTED BREATH NORMAL BREATH TIME MINIMUM AIRWAY PRESSURE Figure 6 1 Normal breath versus an assisted breath The assist is triggered by a negative pressure relative to the end expiratory pressure during the expiratory hold period To perform an assist test 1 Press the FULL key to bring up the FULL TEST screen 2
105. mat in which to print your information The VT PLUS can be connected to various printers The following printer languages are supported e HP PCL 3 graphics text or text only e Epson P1 graphics text or text only e ASCII printers in both 40 and 80 characters per line text only Consult your printer s user manual to determine if it is compatible with these printer languages Please note that the printer may require a special dip switch setting to support a given language To select the printer options follow these steps 1 Enter the system screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled PRINTER OPTIONS VT PLUS Operator s Manual 4 11 4 12 3 Press the MODIFY soft key Printer Options Printer Type ASCII 80 Char Graphics Text Only Printer Type To choose a printer follow these steps 1 Use the and or v soft key to highlight the line labeled PRINTER TYPE 2 Press the MODIFY soft key until the desired printer is displayed 3 Press BACK to return to menu options Graphics To choose the type of reports shown follow these steps 1 Use the and or v soft key to highlight the line labeled GRAPHICS 2 Press the MODIFY soft key until the desired option is displayed 3 Press BACK to return to menu options Audio Levels This adjusts the level of sound for the functions of the VT PLUS To adjust the sound follow these steps 1 Enter the system screen from the se
106. n as follows 1 Enter the setup menu by pressing the SETUP key 2 Press the and v soft keys to select UTILITIES and then press the ENTER soft key 3 Press the and v soft keys to select OXYGEN CALIBRATION and then press the ENTER soft key De Calibration Oxygen Precent 94 0 Barometric Pressure 640 3 mmHg Flou Rate 0 00 LPM Please ensure that barometric pressure is correct before calibrating or zeroing oxygen ZERO Apply Ory Air at gt 16 LPM CAL Rppl u 166 Oxygen at gt 18 LPM lt Note When AIRWAY is selected the airway transducer will be connected to the currently selected Safety Error Messages Troubleshooting and Support 4 Apply 10 Ipm of dry air to the high flow inlet or exhaust On the OXYGEN CALIBRATION screen select the ZERO soft key Press OK to start 2196 O calibration Allow the full 2 minute period Do not press skip 6 Verify that the O reading is 20 9 0 1 7 Apply 10 lpm of dry 100 oxygen to the high flow inlet or exhaust 8 Onthe OXYGEN CALIBRATION screen select the CAL soft key Press OK to start 100 O calibration Allow the full 2 minute period Do not press SKIP 9 Verify that the O reading is 100 0 1 4 Replacing the Fuses The VT PLUS s fuse compartment is located on the side panel of the instrument COMPARTMENT Figure 7 1 The VT PLUS Fuse Compartment To change the fuses 1 Turn the VT PLUS off and unplug the main power cord 2 Using a
107. n the oxygen sensor is calibrated or zeroed there should be sufficient gas flow pass the oxygen sensor Only a small flow of gas say 10 LPM is needed to ensure that the oxygen concentration at the oxygen sensor is as expected For example just opening the high flow exhaust to room air does not ensure that the oxygen sensor will see 20 9 oxygen The oxygen concentration at the sensor will not equilibrate with the room air unless a small amount of flow is present to ensure gas mixing The oxygen sensor should last for greater than 2 years The VT PLUS will check to detect if the oxygen sensor is depleted every time an oxygen zero is performed Overview The oxygen sensor should be recalibrated by the user with 100 oxygen and dry air about once per month Refer to Chapter 7 Safety Error Messages Troubleshooting and Support for more details Flow Measurements The flow measurements in the VT PLUS are made by measuring the differential pressure across a resistive screen mesh The resulting differential pressure is nearly linear with respect to the volumetric flow Simple corrections are applied to correct for any non linearities A table of correction factors is applied for each the low and high flow sensors The information regarding these tables can be seen using the SETUP UTILITES LINEARIZATION screen on the VT PLUS Gas Settings The flow measurement sensors in the VT PLUS are linearly dependent on the viscosity of the applied gas
108. nformation e VT PLUS serial number e The specific steps which reproduce your problem e A daytime phone number e Your name company e A fax number if available 3 Insure the unit for full retail value and ship to Fluke Biomedical Corporation Service Department 5200 Convair Drive Carson City NV 89706 USA Or ship to the European Service Center Adquipment Medical BV R ntgenweg 13 NL 3200 CA Spijkenisse The Netherlands Tel 31 181 612151 Fax 31 181 612184 E mail nbeek adquipment nl Internet www adquipment nl Safety Error Messages Troubleshooting and Support VT Plus PC Software Chapter 8 muda Getting Started Overview of VT Plus for Windows Software Menus and the Tool Bar Screens and Tests Serial Communications Data and File Handling Printing Loading Flash Memory Plots 10 Zeroing 2 3 4 5 6 T 8 9 11 Other Setup Functions l Getting Started System Requirements e Microsoft Windows 95 98 NT e 8 MB of RAM required 32 MB of RAM recommended e 100 MHz Pentium system required 200 MHz Pentium II system recommended On slower computers the VT PLUS software may not be able to display the real time waveform data If you are using a slower computer than recommended and a problem occurs select PARAMETERS ONLY from the COMMUNICATIONS menu Connecting to the VT PLUS The VT PLUS uses a standard 9 pin serial cable to connect to a PC Simply plug
109. nne 4 4 Relative HUMIC ya erica 4 4 Correction Mode cccccccnnccococonononononocononononcnnnnonnnnnnnnnnonnnnnnnnnnnnnnnonnnononannnnnnnnnns 4 5 Barometric Pressure Units ccce esee 4 5 Barometric Pressure camita dz 4 5 Bre tli Detectloh ete eta retta eden 4 6 Breath Detection Threshold eeeeeeeeeeeeeeeeeeeeee enn 4 6 Inspiratory versus Expiratory Tidal Volumes eeeene 4 7 Zero Mode ree ec duce decente dvd eere y pd rede ds 4 7 SySlem as inae eicere EP tuo c cis fe pee pude desee ee n dees ene 4 8 WANG ies cs e 4 8 BEER 4 9 Date Format enun dice DeC RU DA Ql ed 4 9 Demo Dala pp not secs o o e hg 4 10 A E 4 10 Display Calibration Date on Startup Screen sss 4 10 Serial MOd6e 3 56 sion Mi ait be LIII iS ot LM PL PE dol dedo ioco 4 11 Printer eso 4 11 Audio Eevels4 n NUGLUENUU in eo o ok on eu ME 4 12 Restore Defaults sco Spe tin 4 14 Utiles o LM t cde Ree Cel 4 14 Oxygen Galibrationa 2 iode rite creer ter Pere neret re ce De EH Eee 4 14 System Diagnostics sesssssssssseseeeeeeeenee nennen nennen nennen nnne 4 14 Eiriearizatlomz IIR E 4 15 Unlock Calibration ccccccoccccnononocanooonononononanaononnnnnnonananonononononanannnnnnnnnons 4 15 MOMO e tte eet est E 4 15 Chapter 5 Display Screens Screen OD ec ist ott tte uten p decas n etd ene 5 1 Selecting Paraimelers eie Ee eO 5
110. ns If this option is subsequently deselected the previous parameter selections for each screen will need to be re selected VT PLUS Operator s Manual 5 5 5 6 3 Flow Screens High Flow 166 a8 56 A 6 a8 Statistics Mint 168 T 5H H Max 154 H Bg 6 na 166 4 Tidal Vol B 8 ml PEF 4 66 LPM FIF amp Ba LFM Breath Rate A bpr High Flow Screen The high flow screen is used to display the signal and statistics for flow in the high flow port of the VT PLUS Range Units Re scale lt Note Clear Press the soft key below RANGE to change from a low flow screen to a high flow screen or back again Press the soft key below UNITS to change the units of measure for the high flow screen Possible units of measure for this screen include LPM Liters per minute CFM Cubic feet per minute LPS Liters per second ml min Milliliters per minute ml sec Milliliters per second Press the soft key below RESCALE to change the scale on the plot of data to a more appropriate window of values RESCALE uses the current Min Max values to determine plot limits Press the soft key below CLEAR to reset the statistics and re start the plot The user can select the breath parameters displayed in this screen Follow the instructions on page 5 5 to select which breath parameters are displayed in this screen PX Note After CLEAR soft key is pressed allow one full waveform cycle to plot before pressing RES
111. nu print Version retrieves boot and flash version aaaaaaaaaaaaaaaaaaaaalbbbbbbbbbb bbbbbbbbbbb lt CR gt lt LF gt aaaaaaaaaaaaaaaaaaaaa Boot Version XX XX XX bbbbbbbbbbbbbbbbbbbbb Flash Version XX XX XX Last LASTCAL retrieves last cal date Aaaaaaaaaa Calibration Aaaaaaaaaa Last calibration date in the format mm dd yyyy Calibration CALDUE retrieves cal due date Aaaaaaaaaa Due Aaaaaaaaaa Calibration due date in the format mm dd yyyy produces a text printout of all test No response Printout equivalent to signals to the attached printer of the the manual text printout produced VT PLUS using the printer defined in from the user interface of the vt the setup menu plus Zero Mode ZEROspaceXXXX sets zero mode to manual or No Response Manual automatic xxxx MAN or AUTO Zero Breath Detect BREATHspaceXXX selects breath detection to No Response Mode OFF BLIN EX xxx OFF BLIN EX Correction CORRspaceXXXXX selects ATP STPD BTPS No Response Units correction units xxxxx ATP STPD BTPS Gas Type GASspaceXXXX selects No Response AIR 02 HE N20 02 HE 02 N2 O2 XXXX N2 N20 CO2 User as gas type AIR 02 HE N20 02 HE 02 N2 O2 USER N20 N2 CO2 VT PLUS Operator s Manual B 5 Command Name Xx 00 51 programs the VT PLUS for the flowing gas temperature Transmit String Command Description Response String GASTEMPspaceXX Ambient Temp AMBTEMPspaceXX programs the VT PLUS for a specific No Response ambient tempe
112. onversion factors for gas volume and flow measurements e ATP conversion for gas flow and volume to ambient temperature and pressure e STPD conversion for gas flow and volume to a standard temperature of 0 C and a standard barometric pressure of 760 mmHg e STPD 2 conversion for gas flow and volume to a standard temperature of 21 C and a standard barometric pressure of 760 mmHg e BTPS conversion for gas flow and volume to body temperature of 37 C with 100 relative humidity VT PLUS Operator s Manual 5 15 5 16 Display Screens Special Functions Chapter 6 Trend Test Leak Test Stacked Volume Test RT200 Emulation Mode Assist Test High Frequency Oscillator Mode 1 Trend Test The trend test is used to examine a single breath parameter over an extended period of time The trend test checks the parameter to see if it deviates beyond the limits set by the user The limits are set as a percent variation from the initial measured value There are two ways to access the trend screen 1 Press the FULL 5 key to display the breath parameters 2 Press the soft key below TREND Or 1 Press the MORE 4 key 2 Use the and v soft keys to highlight TREND TEST 3 Press the soft key below ENTER After selecting TREND TEST the TREND TEST setup screen is displayed Trend Test Test Parameter Minute Vol x Limit 5 E Current Value 0 000 Use Printer Ho Use the and v soft keys to hig
113. ory fittings such as gas sampling Y pieces and gas sampling adapters The inner lumen of the low flow ports are threaded to accept a standard 14 NPT fitting A A Pressure inside the low flow port should not exceed 120 cmH5O Only dry gasses should be measured using the low flow port Do not use this port to measure exhaled or artificially humidified gasses High Pressure and The high pressure ports are primarily designed for testing wall and tank pressurized gas sources The connector mates to standard oxygen DISS fittings as used on oxygen supply hoses Note that only the side can be used to measure fluid pressure A Applied differential pressure to either side of the high pressure port should not exceed 100 psi Installation A The negative side of the high pressure port can not be used to measure fluid pressure Low Pressure and The low pressure ports connect using standard luer fittings Note that only the side can be used to measure fluid pressure A Pressures applied to either side of the low pressure port should not exceed 500 mmHg Negative side of the low pressure port cannot be used to measure fluid pressure Quick Installation Operations Guide High or low flow ranges can be used for ventilator testing One test setup is measuring ventilator parameters using a test lung You can choose either a bi directional flow mode or a uni directional flow mode as illustrated below howev
114. ports of the VT PLUS Range Units Re scale PX Note Clear Press the soft key below RANGE to change between low pressure airway pressure and high pressure screens Press the soft key below UNITS to change the units of measure for the low pressure screen Possible units of measure for this screen include mbar millibar 001 BAR bar 14 7 PSIG Barometric mmHg millimeters of mercury inHg inches of mercury cmH O centimeters of water inH5O inches of water PSIG pounds per square inch atm atmospheres kPa kilopascals Press the soft key below RESCALE to change the scale on the plot of data to a more appropriate window of values RESCALE uses the current Min Max values to determine plot limits Press the soft key below CLEAR to reset the statistics and re start the plot The user can select the breath parameters displayed in this screen Follow the instructions on page 5 5 to select which breath parameters are displayed in this screen VT PLUS Operator s Manual 5 9 5 10 Airway Pressure Screen The airway pressure screen is used to display the signal and statistics for whichever range is currently selected in either the high or low flow ports of the VT PLUS This screen is used to measure the pressure in a ventilated test lung The airway pressure displayed is the airway pressure for the selected high or low flow port Range Units Re scale D4 Note Clear Press the soft key below
115. r the breaths that have been tested is calculated and displayed here Number of Breaths This 1s the number entered at the start of the test It will not change during a test Breath Count This is the current number of breaths that have been included in the test If tidal volume can t be calculated for a breath then that breath and volume is not included in the test Ending the Stacked Volume Test The stacked volume test may be ended at any time by clicking the STOP button Otherwise the test will end following the number of requested breaths Click the PRINT button to print out a report of the test To start a new test click the NEW TEST button VT PLUS Operator s Manual 8 17 8 18 YT Plus for Windows A Monitor Screen f Single Plot Screen f Loop Screen f Full Test f Trend Test f LeakTest A Figure 8 9A Stacked Volume Test screen E VT Plus for Windows A Monitor Screen f Plot Screen 4 Loop Screen f Full Test f f LeakTest A Figure 8 9B Stacked Volume Test screen VT Plus for Windows 5 Serial Communications Selecting COM Port The VT PLUS communicates with your PC through a serial COM port If the VT PLUS is connected to your computer and turned on when the software is started the software will automatically detect which COM port the VT PLUS is on and then initiate communications between the VT PLUS and your PC While running VT Plus for Windows you may select Com Port from the
116. r values of month and date less than 10 a leading zero must be entered For example if the month is February the user must enter 02 rather than 2 Date Format The VT PLUS has two date formats as shown below MM DD YYYY and DD MM YYYY VT PLUS Operator s Manual 4 9 To change the format follow these steps 1 Enter the system screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled DATE FORMAT 3 Press the MODIFY soft key until desired format is displayed 4 Press the BACK soft key to return to menu options Demo Data This setting allows the user to show recorded data on screen without needing to hook up to a ventilator or do any measurements The word DEMO will appear on the menu bar when this mode is engaged The recorded data is for demonstration purposes To select this function follow these steps 1 Enter the system screen from the setup menu 2 Usethe and or v soft key to highlight the line labeled DEMO DATA 3 Press the MODIFY soft key to turn it on or off as desired 4 Press the BACK soft key to return to menu options Filtering This setting is used to adjust the transition of signals on the flow meters The filter has four settings soft medium hard and off DX Note When filtering is on full test parameters are invalid To change this option follow these steps Enter the system screen from the setup menu 2 Usethe and or v soft key to highlight the line l
117. ration Preface Safety Considerations Warnings and Cautions Use of this instrument is restricted to qualified personnel who recognize shock hazards and are familiar with safety precautions used when operating electrical equipment Read the manual carefully before operating the VT PLUS xx The following warning and informational symbols may be found on the VT PLUS Symbol Description ns Alternating current A N Caution refer to accompanying documentation O Off power disconnection from mains On power connection to mains Caution risk of electric shock Direct alternating current es Direct current de Protective earth ground lt Inspect the lead ends for possible wear cracks or breaks before each use lt If operating the VT PLUS at 110 and 220 volts turn the power switch to the OFF position before changing the supply voltage VT PLUS Operator s Manual V vi Hazard Warnings PX Warning Power Rating The VT PLUS mains power input must be connected to an external power supply that provides voltage and current within the specified rating for the system DX Warning Internal Voltage Always turn off the power switch and unplug the power cord before cleaning the outer surface of the VT PLUS DX Warning Liquids Avoid spilling liquids on the analyzer fluid seepage into internal components creates a potential shock hazard Do not operate the instrument if internal components are exposed to flui
118. rature Relative Humidity RHspaceXXX Xxx 0 100 FLOWspaceXXXX Flow Range Xxxx HIGH or LOW FLOW Flow Pressure PRESSspaceXXXXXX XXXXXX HIGH LOW AIRWAY VOLUME BARO SETBARO XXXX Oxygen Concentration Barometric Pressure Set Barometric Pressure XXXX pressure in mmHg Full Test FULL programs the VT PLUS for the relative humidity selects HIGH or LOW flow range causes the VT PLUS to measure high flow values or low flow values dependent on the range selected This command must be preceeded by the FLOW Range command causes the VT PLUS to measure differential gauge pressure or airway pressure High 100 psi range Low 500 mmHg range Airway 120 cmH20 range airway pressure value based on selected flow range causes the VT PLUS to measure O concentration at the high flow port in the range of 0 100 causes the VT PLUS to measure barometric pressure Allows the user to set the barometric pressure causes VT PLUS to execute a full test returns all measured ventilator parameters Xxx xx lt CR gt lt LF gt XXX Xx returned value in lpm Xxx x lt CR gt lt LF gt XXX X returned value in psig for HIGH range xxx x returned value in cmH20 for LOW range XXX X returned value in cmH20 for AIRWAY range Xxxxx lt CR gt lt LF gt Xxxxx returned value in ml Xxx x lt CR gt lt LF gt Xxx x returned value in xx x lt CR gt xx x r
119. re information placed into the data files by the user VT Plus for Windows provides an interface for the user to mark events during data collection VT Plus for Windows can generate three different file types Vlp The vtp files are generated when the user selects to save data to a file These files contain signal parameters and event information sig Signal file of raw waveforms The sig files are generated from the vtp files using a file conversion program This is done by selecting GENERATE A SIGNAL FILE from VT Plus for Windows FILE menu bar Files must be closed to enable this option The sig files are in ASCII format and can easily be imported into your favorite spreadsheet par Breath by breath calculated ventilator parameters The par files are generated from the vtp files using a file conversion program This is done by selecting GENERATE A PARAM FILE from the VT Plus for Windows file menu bar Files must be closed to enable this option The par files are in ASCII format and can easily be imported into your favorite spreadsheet VT Plus for Windows has a simple means to annotate data files Each of the annotations will be marked as an event in the data file When the data files are played back the annotated text and the time of the event will be displayed on the screen Events VT Plus for Windows supports six different types of events 1 Start of file 2 Beginning of a recording 3 Time stamp
120. ressure PEEP Lung Compliance Leak Test LEAKspaceXXX XXX test time in seconds Leak Stop LEAKSTOP Trend Test TRENDspaceAAAAspaceBBBBB AAAAAA Test Parmeter MV Minute Volume TV Tidal Volume PIF Peak Inspiratory Flow PEF Peak Expiratory Flow BF Base Flow COMPL Compliance BR Breath Rate ET Expiratory Time IT Inspiratory Time EHOLD Expiratory Hold Time IHOLD Inspiratory Hold Time PIP Peak Inspiratory Pressure MAP Mean Airway Pressure IPP Inspiratory Pause Pressure PEEP Positive End Expiratory Pres BB Limit TRENDSTOP Stop Trend Test Minimum MINPRESS Airway Pressure B 8 the pressure at the end of expiration the dynamic compliance starts the leak test Measures the leak rate of the selected pressure channel User must run the PRESS command prior to running the test to select the pressure channel Returns the result after the preset test time in seconds stops the leak test before the completion of the preset test time Caclulates the leak rate based on the stop point executes the trend test utilizing the test parameter and limit variable stops the trend test and transmits a report via RS232 minimum airway pressure over last breath PEEP Minimum pressure over the last breath If less than zero it is set to zero Xxx x lt CR gt lt LF gt XXx x returned result in cmH20 Xxx x lt CR gt lt LF gt Xxx x returned result dynamic compliance ml
121. rinter t work with the selected VT PLUS printer mode Connect printer If the VT PLUS does not eventually communicate with the PC software ensure the cable is correctly connected and that the PC hardware can support the communication port selected Make sure no other device is trying to use the serial port on your PC Close any software that may be using the serial port Make sure that Windows recognizes the serial port in the Control Panel Restart the VT Plus for Windows software 7 12 7 Returning the VT PLUS for Service If your new VT PLUS fails to start or operate successfully please contact Fluke Biomedical s Technical Assistance Center immediately The Fluke Biomedical Technical Assistance Center may be contacted between the hours of 6 30 AM and 5 00 PM Pacific Daylight Time Monday through Friday except holidays Phone 800 648 7952 Fax 775 883 9541 Internet www flukebiomedical com E mail techservices Oflukebiomedical com Outside the USA 775 883 3400 If repairs are required the VT PLUS should be returned to the factory packed in the original shipping container using packing materials supplied by Fluke Biomedical 1 Pack the instrument carefully using the original packing materials If the original packing materials are not available contact Fluke Biomedical for replacement packing Failure to pack the instrument properly could void your warranty 2 Enclose the following i
122. s Area Plot Area Screen Tabs Status Bar Selected Flow Port Correction Mode Zeroing Mode Selected File V System Messages VT Plus for Windows 3 Menus and the Toolbar Pull down Menus Like all Windows programs VT Plus for Windows O provides you with a menu for easy access to the program s functions A brief description of the software s menu structure follows File Communications Plots Statistics Zero Setup Help Figure 8 1 Menu bar File This menu gives access to the file handling and printing functions of this software For a complete description see the Data and File Handling section in this chapter Communications The communications menu allows you to select the communications port and the serial data mode For a complete description see the Serial Communications section in this chapter Plots The plot menu provides access to the plot re scaling functions It allows you to change the plot on any of the monitors and turn on or off the automatic re scaling For a complete description see the Plots section in this chapter Statistics The statistics menu gives access to the clear function for any or all statistics The CLEAR ALL function will clear the statistics for all the signals at once to clear individual signals select the option with its name Zero The zeroing menu allows you to manually zero any or all of the signals The ZERO ALL function will zero all the signals except oxygen To zero any
123. ser to fine tune the barometric pressure measurement The difference between the value measured by the VT PLUS and the entered value will be applied to future VT PLUS measurements as a correction factor The correction is applied as an offset correction The correction factor is stored in non volatile memory and is remembered when the VT PLUS is turned off then back on VT PLUS Operator s Manual 4 5 4 6 To enter a barometric pressure value follow these steps Enter the settings screen from the setup menu Use the and or v soft key to highlight the line labeled BAROMETRIC PRESS Press the soft key below MODIFY Use the numeric keys to enter the barometric pressure in mmHg Press the soft key below ENTER to exit back to the menu options or the ESCAPE soft key to cancel the change and return to menu options He py c9 ce Note that the VT PLUS accepts barometric pressure values between 0 and 999 mmHg No decimal values or fractions of a mmHg are allowed Breath Detection The VT PLUS can be used to measure parameters on a breath to breath basis To measure breath parameters the mode of breath detection must be set The breath detection options are as follows ar Bi directional breath detection Use this breath detection mode when analyzing both inspired and expired breath data or when the VT PLUS is connected between the load lung simulator and the Y piece in the breathing circuit Uni directional inspired only Use this breath
124. small flat blade screwdriver or similar tool carefully pry off the cover to the fuse compartment The fuse block assembly is attached to the back of the cover 3 Carefully lift the old fuses from the fuse slot 4 Replace the fuses Use two 0 5 A Slo Blo fuses Fluke Biomedical P N 46026 Replace the cover on the fuse compartment and plug in the VT PLUS A Warning Using other than a recommended fuse can cause fire and or shock VT PLUS Operator s Manual 7 3 5 Error Messages Flow Out of Range Gas Settings Error Airway Pressure Out of Range Low Pressure Out of Range High Pressure Out of Range Linearization Tables Invalid 74 Occurs if differential pressure for the flow measurement causes a measurement greater than the maximum or less than the minimum reading of the analog to digital converter CORRECTIVE ACTION Ensure that flow is within the specified range of the VT PLUS Occurs if oxygen concentration is measured at greater than 5096 and the gas settings are not set to an oxygen or a balance oxygen setting This is provided as a warning to set the gas settings if measuring flow with a gas type that has high oxygen concentrations CORRECTIVE ACTION The error warning will only occur once after the VT PLUS is powered on If measuring flow ensure that the correct gas setting is being used for gas type being measured Occurs if airway pressure measurement causes a measurement greater than the maximum or l
125. t of valves is used to select between high and low flow ranges Since one pressure transducer is used for both zeroing one flow range also zeros the other In the manual zero mode if the user presses the ZERO key when the VT PLUS is at the FLOW screen a message will appear indicating that the flow must be removed from the currently selected flow port The user must remove the flow so that a correct zero reading can occur In the autozero mode the VT PLUS uses the valves that switch between the high and low flow ports to obtain a zero reading It is assumed that there is no flow in the unselected port The purpose of this is to provide a means to zero the flow without having to disconnect from the ventilator circuit or other flow source being measured lt Note When autozeroing is selected it is important that there is no flow on the unselected flow port For example if the high flow range is selected there should not be any flow in the low flow port if autozeroing is selected When autozero is selected the user may still push the ZERO key to initiate a flow zero The valves will still automatically switch to obtain the zero reading Therefore it is not necessary for the user to disconnect the flow to zero No message will appear indicating that the flow source should be removed With the autozero setting enabled the flow will automatically zero every 5 to 10 minutes Since some data is lost during a zero ventilator parameter data
126. ted Parameters The following is a list of parameters calculated by the VT PLUS A breath detection algorithm determines the various phases of a ventilator breath and then the following parameters are calculated 1 8 Parameter Abbreviation How Calculated Inspiratory Time Expiratory Time Inspiratory Hold Time Expiratory Hold Time Inspiratory to Expiratory Time Ratio Inspiratory Hold Pressure Positive End Expiratory Pressure Mean Airway Pressure Peak Inspiratory Pressure Tidal Volume Minute Volume Peak Inspiratory Flow Rate Peak Expiratory Flow Rate Compliance In Time Ex Time In Hold Ex Hold E IPP PEEP MAP PIP Tidal Vol Minute Vol The time of the inspiratory period including the inspiratory hold time The time of the expiratory period including the expiratory hold time The time of the End Inspiratory State The time of the End Expiratory State The ratio of the inspiratory time to the Expiratory Time The average pressure during the End Inspiratory State The average pressure during the End Expiratory State The mean pressure over the entire breath The maximum pressure during the Inspiratory Time Total volume accumulated over the Inspiratory Time The Expiratory Tidal Volume times the respiratory rate in breaths per minute Reported as an eight breath average The maximum of the absolute value of the Flow Rate measured during the Inspiratory Time
127. test Hof Tests Incremented each time a breath is detected of Incidents The number of incidents is incremented each time the percent difference exceeds the percent limit Elapsed Time This value is updated continuously It keeps track of the length of time the current trend test has been run Ending the Trend Test The trend test may be ended at any time by clicking the STOP button When the trend test is stopped the final values are reported Clicking the PRINT button will print out a copy of the results and the incident reports for the test Click the NEW TEST button to start a new trend test VT Plus for Windows X VT Plus for Windows Minute Volume VT Plus for Windows Figure 6 7B Trend Test screen VT PLUS Operator s Manual 8 13 8 14 VT Plus for Windows Xblonitor Screen f Singe Pot Screen Loop Screen A Fall Test NeeTest _ em Figure 8 7C Trend Test screen A LeakTest A Stacked Volume Test Low Flow VT Plus for Windows Leak Test Screen Overview The leak test is for measuring the leak rate of a sealed vessel or test lung over a period of time Starting the Leak Test The leak test gives you the chance to choose the pressure channel you want to run the test on Also you can change the units that the pressure is displayed in If you choose to enter a compliance value for the system being tested the volume lost during the test w
128. the equipment This equipment has been tested and found to comply with the limits for a Class A digital device pursuant to Part 15 of the FCC Rules These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment Like all similar equipment this equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with the instruction manual may cause harmful interference to radio communications Operation of this equipment in a residential area is likely to cause interference in which case the user will be required to correct the interference at his her own expense Xx Canadian Department of Communications Class A This digital apparatus does not exceed Class A limits for radio emissions from digital apparatus set out in the Radio Interference Regulations of the Canadian Department of Communications Le present appareil numerique n met pas du bruits radioelectriques depassant les limites applicables aux appareils numerique de la Class A prescrites dans le Reglement sur le brouillage radioelectrique edicte par le ministere des Communications du Canada Preface this device bears the C mark C Based on the testing standards below EC Directive 89 336 EEC Electromagnetic Compatibility P4 Emissions Class A The system has been type tested by an independent accredited testing laboratory and found to meet
129. the number of tests taken and the number of breaths incidents in which the limit has been exceeded is also displayed An example of the test report printout is shown on the next page Special Functions To terminate the test press the soft key below STOP After the trend test is ended the following report screen is shown A sample Trend Test Report is shown on the following page Trend Test Test Parameter Current Value L Starting Value L a 4 x Difference x Limit of Tests of Incidents Elapsed Time VT PLUS Operator s Manual 6 13 2000 Control Tech TREND TEST REPORT 10 45 VT Plus S N S N 4294967295 eae eS Se eS aa Incident Report Test Parameter Minute Vol Current Value 40 333 L Difference 41 of Tests 1 Parameters Minute Vol 40 333 L Tidal Vol 1384 8 ml PIF 109 42 LPM PEF 113 91 LPM Base Plow LPM Compliance m cmH20 02 18 5 3 Baro Press 645 1 mmHg Gas Air Final Report Test Parameter Minute Vol Starting Time 10 45 30 Elapsed Time 0 00 07 of Incidents 1 6 4 Elapsed Time Starting Value Limit of Incidents Breath Rate Ex Time In Time Ex Hold In Hold I E Ratio PIP MAP IPP PEEP Starting Value Ending Time Limit of Tests 0 0 2 29 0 9 1 1 0 0 0 0 1 2 1 1 9 0 0 0 0 0 0 2 10 0 05 8 686 L 53 1 bpm Sec Sec Sec cmH20 cmH20 cmH20 cmH
130. the open data file A TIME STAMP event marker is placed in the data file indicating the beginning of recording The play button initiates data playback from an open file The stop button terminates data recording or playback The data file is left open The pause button stops data playback temporarily Files should be paused before printing so that the desired plot is captured for printing This button rewinds the data file to its beginning This only affects data playback All recording is done at the end of the data file This button will back up the data file during playback to the previous event marker in the file Automatic event markers provide periodic events for the file to be rewound or forwarded to This button may be enabled during data playback to allow for continuous play In continuous play the data file will automatically rewind to the beginning of the file as soon as the end of the file is reached This button advances the data file during playback to the next event marker in the file Automatic event markers provide periodic events for the file to be rewound or forwarded to This button advances the data file to its end This only affects data playback The speed control is provided to adjust the playback speed The number shown is the time in milliseconds ms between waveform samples The data sample rate for the VT PLUS is 20 ms Therefore a number larger than 20 will result in slower than normal playback
131. tion Before unpacking the VT PLUS visually inspect the shipping box for damage e If no damage is evident unpack the VT PLUS and use the checklist below to ensure that you have received the tester s accessories Save the foam inserts and shipping box You must use the original packing materials when shipping the VT PLUS for service or re calibration If the original shipping carton and packing materials are not available call a Fluke Biomedical service representative for assistance e If the shipping box is damaged unpack the tester and inspect it for visible dents and scratches gt If the instrument is damaged notify the carrier and your distributor representative Keep the shipping cartons and packing materials for the carrier s inspection Call a Fluke Biomedical service representative to arrange for repair or replacement of your instrument without waiting for the claim against the carrier to be settled After unpacking the VT PLUS use the following checklist to ensure that you have received everything In addition to the tester and this manual you should have e A power cable Fluke Biomedical Part Numbers US 75011 Schuko 75010 UK 75012 Australia 75013 e An accessories kit containing the following items One bacterial filter for external connection to the flow ports P N 48479 4 Tubing 1 8 ID clear w blue stripe P N 67535 Two 22 mm ID x 22 mm ID tubing adapters P N 48472 Two 22 mm OD x 22 mm OD tubing adapters P N 48473
132. tional Breath Detection Flow Threshold This button brings up a dialog box for entering the breath detection flow threshold For more information see the Setup Functions section on page VT PLUS Operator s Manual 8 7 8 8 Screens and Tests Main Screens VT Plus for Windows has seven main screens You may switch between displayed screens by selecting the appropriate file tab on the bottom of the screen Monitor Screen The Monitor Screen allows you to observe three of the signals at the same time Each plot can be configured to display any of the signals flow volume airway pressure low pressure high pressure and oxygen Each plot can be independently set to auto scale or manually re scaled to the user s desired range of values On the right hand side of the screen the statistics for the selected signals are displayed These statistics show the min max average and current value for the signal that is currently displayed For more information on configuring plots refer to Signal Selection Automatic Re scaling and Manual Re scaling this chapter 4 T Plus for Windows Bil x File Communications Plots Statistics Zero Setup Help ermelo 2 E E 166 81 Tos dii 17 16 LPM Min 90 16 Max 158 87 Avg 2 99 0 5 10 15 20 Airway Pressure Airway Pressure 0 6 cmH20 Min 22 7 Max 55 4 Avg 0 0 1062 5 om boi 77 2m Min 1 1 Mac 1011 9 Avg 380 0
133. to change the measurement units i e LPM CFM LPS etc Press the soft key below RESCALE to change the plot scaling The new scaling will be based upon the minimum and maximum values shown in the statistics area Press the soft key below CLEAR to erase the plot and re initialize the statistics and breath parameters For more information in any screen press the HELP key Press PAUSE RESUME key to pause the screen Press the key again to resume the plot Refer to Chapter 5 Display Screens for a more detailed description of the various screens and modes 3 Attaching the Printer Cable The printer is set up for parallel printing The printer uses a D25 Male to Centronics parallel cable available from a Fluke Biomedical representative Fluke Biomedical P N 71072 or from most electronic supply outlets To attach the parallel cable 1 Connect the 36 pin end for the Centronics type parallel cable to the printer s parallel input connector 2 Attach the 25 pin male end of the parallel cable to the 25 pin connector on the back of the VT PLUS Chapter 4 System Setup provides a more detailed description of the various printers Installation Keypad Functions Chapter 3 1 VT PLUS Keypad Functions 1 VT PLUS Keypad Functions Figure 3 1 illustrates the VT PLUS keypad The various keys and their functions are described on the following pages VT Plus GAS FLOW ANALYZER Biomedical Contrast Adjustment Pause Resume
134. to measure oxygen in the low flow port make sure that the flow of gas is passed through the high flow port also to measure oxygen Re scale Press the soft key below RESCALE to change the scale on the plot of data to a more appropriate window of values Clear Press the soft key below CLEAR to reset the statistics and re start the plot The user can select the breath parameters displayed in this screen Follow the instructions on page 5 5 to select which breath parameters are displayed in this screen Refer to Chapter 7 for instructions on how to calibrate the oxygen sensor Display Screens 7 Full Breath Parameters Test Screen Full Test Ventilator Parameters Minute Vol 15 366 LPM Breath Rate Tidal Vol 467 2 ml Ex Time FIF 45 36 LPM In Time PEF 66 39 LPM Ex Hold Base Flows sss LPH In Hold Compliance m cmH20 IE Ratio nz 20 2 PIP Baro Press 6358 8 mmHg MAP Gas Air IFF Min Pres 6 3 cmHz PEEP Assist B 3 cmHz 3T T bpm H 83 Sec B TE Sec 4 BG Sec 6 81 Sec 1 1 69 6 3 cmH20 B B cmH20 HB cmH20 B amp cmH20 The full test screen is used to display all of the breath parameters calculated by the VT PLUS Note that breath detection must be enabled for breath parameters to be calculated See Chapter 4 System Setup for instructions on enabling breath detection Trend Press the soft key below TREND to obtain a printed trend of a single parameter See Chapter 6
135. tory and an inspiratory phase Flow measurements are made using a differential pressure drop across a resistive screen mesh The low flow signal can be used for infant neonatal ventilators or for determining the performance of many other types of flowmeters Valves are used to switch between the low flow and the high flow measurements depending on the range selected in the display flow screens see Chapter 5 Display Screens Airway Pressure The airway pressure is measured from a tap off of the proximal near the exhaust port of the flow sensor housings This tap is connected to a 120 cmH5O pressure sensor that generates the airway pressure signal Valves are used to switch between the low flow and the high flow measurements When the low flow port is selected the airway pressure is measured off the low flow port Likewise when the high flow port is selected the airway pressure is measured off the high flow port Use the soft key below RANGE from any of the flow screens to select which flow port high or low airway pressure is measured from Low Pressure won on This is a dual port connection consisting of a positive and a negative pressure port The differential pressure range is 500 mmHg This pressure measurement can be used for any pressure differential or gauge pressure in the given range The transducer is capable of measuring fluid pressure on the positive port as indicated on the label Barometric Pressure A
136. tup menu 2 Usethe and or v soft key to highlight the line labeled AUDIO LEVELS 3 Press the MODIFY soft key System Setup Rudio Levels Keupad Lou Errors Lou General To adjust the general audio level follow these steps 1 Use the and or v soft key to highlight the line labeled GENERAL 2 Press the MODIFY soft key until the desired option is displayed 3 Press BACK to return to menu options Keypad When keypad buttons are pushed a beep signals this action This option adjusts the sound level of that beep To adjust the sound level of the keypad follow these steps 1 Use the and or v soft key to highlight the line labeled KEYPAD 2 Press the MODIFY soft key until the desired option is displayed 3 Press BACK to return to menu options Error When an error is made the VT PLUS signals it with a beep This option adjusts the sound level of that beep To adjust the sound level of errors follow these steps 1 Use the and or v soft key to highlight the line labeled ERROR 2 Press the MODIFY soft key until the desired option is displayed 3 Press BACK to return to menu options VT PLUS Operator s Manual 4 13 4 14 Restore Defaults This returns all values to the factory defaults listed below but does not change the device calibration To restore defaults follow these steps Enter the system screen from the setup menu 2 Usethe and or v soft key to highlight the line labe
137. uct information on the VT PLUS such as serial number and copyright Information VT Plus Gas Flow Analyzer Serial Number 166749 Boot Version 1 05 00 Boot non Checksum 13526 lash Version 1 05 19P Harun ware Version 1 0c 03 02 0 Flash ROM Checksum DH9ADEO Copyright 1999 VT PLUS Operator s Manual 4 15 4 16 System Setup Display Screens Chapter 5 Screen Objects Selecting Parameters Flow Screens Pressure Screens Volume Screen Oxygen Screen Full Breath Parameters Test Screen Monitor Screen Units of Measure 1 Screen Objects The screens on the VT PLUS comprise a title bar data plot s instantaneous value of plotted data statistics of plotted data and selected breath parameters The following is a description of the meaning and function of each of these screen options Data 8 8 Statistics Plots Min 168 7 3H B Max 154 6 Avgi B B8 ug Tidal Val amp aml PEF B 6 LPM Parameters 5 FIF BB LPM Breath Rate A berm 5 2 TITLE BAR Each screen includes a title bar that shows the screen or mode name on the left A number indicating the screen number is shown in a small box on the right of the title bar Parameters Indicates the screen number ICONS The breath detection icon is located on the right side of the title bar and indicates whether breath detection is selected as follows 0 a ATF BPs STO ST PDs A large number
138. ume Test emen enne 8 17 Se al Communications ss aanaeio tenorea RUE HERRERA cidecdbascnpacseteananse 8 19 Selecting COM Pott ciet neret Ea conet eae eed Y edere 8 19 Selecting the Serial Communications Mode sssesseesss 8 19 Data and File Handling ic eei a t e ertt etes 8 20 File Structure Background and Theory of Operation sssse 8 20 Events one ete e edge p e ente eine We De Toe eot va dee tis 8 20 Opening and Closing Data Files nm 8 21 File Gontrol Interface coria 8 22 Generating Signal sig Files eeeeennee 8 25 Generating Parameter par Files n 8 25 PINO pee ETE 8 26 Loading Flash Memory sisi eoe ret deeper 8 26 grs e P 8 27 Automatically Re scaling Plots s me 8 27 Manually Re scaling Plots o ooooooccnnnnccc nonaccnnnonannnnoncccnnnoncnornnon mn 8 28 Signal Selection edet tt Te e re dere eae Rd 8 29 LOMA a ionic rp Ue Re Lees 8 30 Manual Zeroing cion e tore lote cette ci 8 30 A ridi RR ERE RR BRUT EAE Apae E aeniea pinsi EROR 8 30 Other Setup Functions creer ea cave ne ti Ye eme e ce oa eee nen 8 31 Breath Detect iiec etam tenete ceperit ee retine odd 8 31 Breath Detect Thiresholds uiui etd scie cres 8 31 Gas Settings o neve pe er eie eU HE EE eie s 8 32 Gas Calculator Cp did 8 34 Barometric PreSSure
139. umidity setting is only used for STPD and BTPS corrections The relative humidity is not used in calculating the effective viscosity on the VT PLUS however the gas calculator in the VT Plus PC Software DOES use relative humidity in determining the effective viscosity of user defined gases Using humidified gases at room temperature may cause flow measurement errors of up to 1 of reading for near saturated non condensing gases Correction Mode This setting calculates the flow volume of the air flowing through the high or low flow ports This should match the correction mode of the device under test To change correction mode follow these steps 1 Enter the settings screen from the setup menu 2 Usethe and or v soft key to highlight CORRECTION MODE 3 Press the MODIFY soft key until the desired option is displayed 4 Press the BACK soft key to exit to the setup menu Barometric Pressure Units These settings represent the various units available to measure barometric pressure such as mmHg To change the barometric pressure units follow these steps 1 Enter the settings screen from the setup menu 2 Use the and or v soft key to highlight BARO PRESS UNITS 3 Press the MODIFY soft key until the desired option is displayed 4 Press the BACK soft key to exit to the setup menu Barometric Pressure The VT PLUS constantly measures the barometric pressure It is displayed on the FULL TEST screen This setting allows the u
140. use pressure e Mean airway pressure e Positive End Expiratory Pressure PEEP e Lung compliance e leak Leak test pressure decay over time e Inspiratory hold time e Expiratory hold time e Peak expiratory flow e Peak inspiratory flow e Base flow VT PLUS Operator s Manual A 3 2 General Specifications Operating Environmental Conditions Temperature Range sese a a nnnm nnne 10 to 40 C Ambient Humidity 0 80 non condensing to 31 C decreasing to 50 at 40 C Barormetric Pressure o t edit ap th esteso dein die ed 8 to 18 psia Vibration Device is intended to be used on tabletop or other stable surface Storage Environmental Conditions Temperature Range ne eh pet tte ee 25 to 50 C steer 0 to 95 non condensing C Power Requirements Maximum Over voltage esses nenne enne nnne nenne nnne nennen nnne 264 VAC Input Voltage Range coocooniccccnnonccncnonocnnnncnnnn nac cancer 100 to 240 VAC Input Frequency Range s sies eene nennen nennen nennen cenar 50 60 Hz Power Consumption essere nens 132 Volt Amperes Fuse Ft llng te Le edet HE E edt Oed 0 5 A Slo Blo 3 Performance Specifications Low Pressure Port Maximum Applied Pressure irona aroei aa aaan 60 psi Operating Pressure Differential senee 500 mmHg 10 psi Operating Pressure Common mode ssssssseeeeeee
141. wing page Leak Test Compliance B B ml cmH2 0 Vol Lost BH aL Start Press 4 B4 Kpa Leak Rate n BG cmHz s Start Time 11 15 38 Elapse Time 0 03 34 Special Functions 1 2 2000 3 05 Control Tech Leak Test Low Press 0 02 Kpa Compliance 0 0 Start Press 0 00 Start Time 03 05 13 Vol Lost 0 0 Leak Rate 0 07 Elapse Time 00 00 03 Parameters Minute Vol 0 000 Tidal Vol 0 0 PIF 0 00 PEF 0 00 Base Flow 0 00 Compliance 0 0 02 20 6 Baro Press 766 6 Gas Air VT PLUS Operator s Manual LEAK TEST REPORT Fluke Biomedical Corporation ml cmH20 Kpa ml cmH20 s L ml LPM LPM LPM ml cmH20 t mmHg S N Breath Rate Ex Time In Time Ex Hold In Hold I E Ratio PIP MAP IPP PEEP VT Plus S N 0 0 0 0 0 0 0 0 kkk k k 0 0 0 0 0 0 0 0 166752 bpm Sec Sec Sec Sec cmH20 cmH20 cmH20 cmH20 6 7 3 Stacked Volume Test The VT PLUS has a function for testing the volume of multiple breaths This function measures how accurate the ventilator is at accumulating volume To access the stacked volume test function follow these steps 1 2 Press the MORE 4 key Use the and v soft keys to highlight STACKED VOLUME TEST Press the soft key below ENTER Press the MODIFY soft key Enter the number of breaths for the test and press the ENTER soft key Press the START or AUTO soft key to begin the test Stacked Volume Test Total Volume
142. xpiratory Testing 1 Connect the expiratory hose to the flow port on the right side of the VT PLUS 2 Connect the flow exhaust port on the left to the ventilator using standard breathing hoses 3 Ensure that the breath detection mode is set to Uni directional Expiratory a Go into Setup b Choose settings c Choose Breath Detect and modify as needed 2 4 Installation M Hose Ventilator Expiratory Hose Outlet Inlet N Figure 2 3 Connecting the VT PLUS to in the expiratory limb of the breathing circuit See Chapter 6 Special Functions for more details The VT PLUS should display a screen similar to that shown in Figure 2 4 The flow of gas delivered by the ventilator is shown graphically on the screen High Flow 186 8 56 A 6 58 Statistics Mint 168 T 5H H Max 154 H Avg 6 Be 166 4 Tidal Vol 6 B ml PEF 4 60 LPH FIF 6 Bia LPM Breath Rate 4 bpr Figure 2 4 VT PLUS flow display VT PLUS Operator s Manual 2 5 2 6 The monitor should display the instantaneous flow rate in large numbers in the upper right portion of the screen The flow statistics min max and average are shown below in the center right portion of the screen A subset of the breath parameters is shown below the flow plot The following are adjustments you can make to the screen Press the soft key below RANGE to switch between the high and low flow ports Press the soft key below UNITS

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